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Clopidogrel linked with mortality reduction in patients with HF not undergoing PCI after acute MI

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Patients with HF who did not undergo percutaneous coronary intervention after their first acute MI and who were treated with clopidogrel had lower mortality when compared with those not assigned to clopidogrel.

Researchers from Denmark identified 31,295 patients discharged for the first time with acute MI who did not undergo PCI within 30 days of discharge. Patients were admitted from 2000 to 2005. Those with HF (n=15,438) were assigned to a cohort, 2,659 of whom were assigned to clopidogrel (Plavix, Sanofi Aventis) and 12,779 of whom were not.

The researchers then created propensity-matched cohorts of patients with HF who were treated with clopidogrel (n=2,525) and those who were not treated with clopidogrel (n=2,525). Among these patients, 15,813 did not have HF; 3,453 were treated with clopidogrel and 12,360 were not. Propensity-matched cohorts included 3,046 patients without HF in each treatment arm.

An interaction between clopidogrel and HF on the effect of clopidogrel on all-cause mortality was reported in the unmatched population (HR=1.17; 95% CI, 1.00-1.33). Patients with HF (n=812) in the matched population died without clopidogrel treatment vs. 709 who were assigned clopidogrel (P=.002). In patients without HF, 294 patients died without clopidogrel vs. 285 assigned to clopidogrel (P=.83). Following Cox proportional hazards analysis, there was a decreased mortality risk associated with clopidogrel treatment in the HF cohort (HR=0.86; 95% CI, 0.78-0.95) but no significant effect in the cohort without HF (HR=0.98; 95% CI, 0.83-1.16).

“To our knowledge, this study is the first to evaluate the effect of clopidogrel on all-cause mortality in patients with HF and acute MI who do not undergo PCI,” the researcher wrote. “Whether these results can be extrapolated to other patients with HF is unknown.”

In an accompanying editorial, Victor L. Serebrauny, MD, PhD, of the Osler Medical Center in Towson, Md., said the results helped clarify whether or not clopidogrel use was justified for all patients with HF.

“Despite some well-recognized limitations, Bonde et al advanced our current understanding of the potential benefit of clopidogrel in reducing all-cause mortality in patients after first MI and associated HF,” he wrote. “Future attempts to improve survival in HF by reducing platelet activation and thrombotic burden are warranted.”

Bonde L. J Am Coll Cardiol. 2010;55:1300-1307.

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