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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Use of early clopidogrel by reperfusion strategy among patients presenting with ST-segment elevation myocardial

Chiara Melloni1, Matthew T Roe, Anita Y Chen

  • 1Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705, USA. mello004@mc.duke.edu

Circulation. Cardiovascular Quality and Outcomes
|October 13, 2011
PubMed

Insights

Early clopidogrel use in ST-elevation myocardial infarction (STEMI) patients is inconsistent, particularly in those not receiving reperfusion therapy. Despite guidelines, uptake remains low, though associated with reduced in-hospital death across strategies.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacology

Background:

  • The 2007 ACC/AHA guidelines recommended clopidogrel with aspirin for STEMI patients, irrespective of reperfusion strategy.
  • A bolus dose of clopidogrel was specifically recommended for patients under 75 years old.

Purpose of the Study:

  • To evaluate the utilization and dosing of early clopidogrel therapy in STEMI patients across different reperfusion strategies.
  • To assess the association of clopidogrel use with in-hospital outcomes, including bleeding and mortality.

Main Methods:

  • Analysis of 52,140 STEMI patients from January 2007 to September 2009 in the ACTION Registry®--Get with the Guidelines (GWTG™).
  • Patients were stratified by reperfusion strategy: primary percutaneous coronary intervention (PCI), fibrinolysis, or no reperfusion, and by age (<75 or ≥75 years).
  • Adjusted odds ratios for in-hospital outcomes were calculated based on early clopidogrel use.

Main Results:

  • Early clopidogrel administration was high in primary PCI (97%) but low in fibrinolysis (18%) and no-reperfusion (6%) groups.
  • Loading doses were frequently used in PCI (91%) but less so in fibrinolysis (83%) and no-reperfusion (74%) patients.
  • Clopidogrel use was linked to significantly lower in-hospital death across all reperfusion strategies, but increased major bleeding in older patients not receiving reperfusion.

Conclusions:

  • Early clopidogrel use has not been widely adopted in routine care for STEMI patients undergoing fibrinolysis or not receiving reperfusion.
  • Adherence to guideline recommendations for clopidogrel in STEMI management remains suboptimal in specific patient subgroups.
Abstract

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