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Published on: January 28, 2020

Prognosis of patients suffering an acute coronary syndrome while already under chronic clopidogrel therapy

Laurent Bonello1, Axel De Labriolle, Gilles Lemesle

  • 1Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 7, 2009
PubMed

Insights

Patients on chronic clopidogrel therapy experiencing acute coronary syndrome (ACS) have a worse prognosis. This suggests potential clopidogrel low-response issues in these high-risk cardiovascular patients.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacology

Background:

  • Chronic clopidogrel therapy (CCT) is established for reducing major adverse cardiovascular events (MACE) post-acute coronary syndrome (ACS) or drug-eluting stent (DES) implantation.
  • However, a subset of patients on CCT still experiences thrombotic events, with their prognosis being unclear.
  • Understanding the outcomes of patients with ACS despite CCT is crucial for risk stratification and treatment optimization.

Purpose of the Study:

  • To evaluate the long-term prognosis of patients who present with ACS while undergoing chronic clopidogrel therapy (CCT).
  • To compare the outcomes of patients with ACS on CCT versus those not on CCT prior to the event.
  • To identify potential factors contributing to adverse events in patients on CCT.

Main Methods:

  • A cohort study of 1,281 patients undergoing percutaneous coronary intervention (PCI) for ACS.
  • Patients were divided into two groups: CCT (n=175, clopidogrel >or=30 days pre-ACS) and no CCT (n=1,106).
  • Cardiovascular death and myocardial infarction rates were compared at 6-month follow-up.

Main Results:

  • Patients in the CCT group were older and had higher rates of diabetes.
  • In-hospital outcomes were similar between groups.
  • At 6 months, the CCT group had a significantly higher rate of MACE (18.3% vs. 11.8%, P=0.02), with CCT associated with a 1.7 hazard ratio for MACE in multivariate analysis.

Conclusions:

  • Patients experiencing ACS despite CCT exhibit a poor long-term prognosis.
  • This poorer outcome may be associated with clopidogrel low-response.
  • Further investigation into mechanisms of treatment failure in this patient subgroup is warranted.
Abstract

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