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The CURE trial: using clopidogrel in acute coronary syndromes without ST-segment elevation
Gregory P Gerschutz1, Deepak L Bhatt
1Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, OH 44195, USA.
Insights
Clopidogrel (Plavix) reduced major cardiovascular events by 20% in acute coronary syndromes without ST-segment elevation. However, this benefit came with an increased risk of bleeding, suggesting tailored treatment strategies may be needed.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Acute coronary syndromes (ACS) without ST-segment elevation require effective antiplatelet therapy.
- Clopidogrel is an antiplatelet medication used in managing ACS.
- Treatment strategies for ACS vary, including conservative and aggressive approaches.
Purpose of the Study:
- To evaluate the efficacy and safety of clopidogrel in patients with ACS without ST-segment elevation.
- To assess the impact of clopidogrel on major adverse cardiovascular events and bleeding.
Main Methods:
- A large, randomized, placebo-controlled trial was conducted.
- Participants presented with acute coronary syndromes without ST-segment elevation.
- The study was performed in centers employing a conservative management approach.
Main Results:
- Clopidogrel significantly decreased the combined endpoint of cardiovascular death, nonfatal myocardial infarction, or stroke by 20%.
- An increase in bleeding events was observed in the clopidogrel group compared to placebo.
- The observed benefits and risks may differ in centers with aggressive early angiography and revascularization strategies.
Conclusions:
- Clopidogrel demonstrates significant efficacy in reducing major adverse cardiovascular events for ACS patients without ST-segment elevation.
- The increased bleeding risk associated with clopidogrel necessitates careful consideration of patient selection and treatment context.
- Treatment strategies involving clopidogrel may require individualization, particularly in centers utilizing early invasive interventions.
Abstract:
In a large, randomized, placebo-controlled trial in centers that use a conservative approach to acute coronary syndromes, the antiplatelet drug clopidogrel (Plavix) decreased the rate of the combined end point of cardiovascular death, nonfatal myocardial infarction, or stroke by 20% in patients presenting with acute coronary syndromes without ST-segment elevation. The benefit was at the cost of an increase in bleeding, however. This strategy may need to be tailored in centers that use a more aggressive treatment strategy of early angiography and revascularization.