Clopidogrel pre-treatment is associated with reduced in-hospital mortality in primary percutaneous coronary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Pre-treatment with clopidogrel is known to reduce ischemic events in non-ST-elevation acute coronary syndromes.
• Limited data exist on the efficacy of upstream clopidogrel administration in primary percutaneous coronary intervention (PCI).

Purpose of the Study:

• To evaluate the impact of pre-hospital clopidogrel loading on outcomes in patients undergoing primary PCI for ST-elevation myocardial infarction (STEMI).

Main Methods:

• A multicenter registry study prospectively enrolled 5955 patients undergoing primary PCI between 2005 and 2009.
• Patients were divided into two groups: clopidogrel pre-treatment (n=1635) and peri-interventional clopidogrel (n=4320).
• Multivariate logistic regression analysis was used to assess the effect of pre-treatment on in-hospital mortality, with subgroup analysis for GP IIb/IIIa antagonist use.

Main Results:

• Univariate analysis showed reduced in-hospital mortality in the clopidogrel pre-treatment group (3.4% vs. 6.1%, P<0.01).
• Multivariate analysis confirmed pre-treatment as an independent predictor of reduced in-hospital mortality (OR=0.60, 95% CI 0.35-0.99; P=0.048).
• The benefit was more pronounced in patients also receiving GP IIb/IIIa antagonists (OR=0.40, 95% CI 0.19-0.83; P=0.01).

Conclusions:

• Pre-treatment with clopidogrel before arrival at the PCI center is associated with significantly lower in-hospital mortality in STEMI patients undergoing primary PCI.
• These findings support the recommendation for prompt clopidogrel administration in STEMI patients scheduled for primary PCI.
• Early clopidogrel loading is a valuable strategy in real-world primary PCI settings.