Clopidogrel pretreatment lowered risk for major cardiac events, not mortality
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Clopidogrel pretreatment for PCI was associated with a lower risk for major cardiac events but not with a lower risk for all-cause mortality, study results found.
The study, which was conducted by the ACTION group, evaluated the effect of clopidogrel pretreatment compared with no treatment on mortality and major bleeding after PCI. The meta-analysis included 15 studies published between August 2001 and September 2012, which comprised six randomized controlled trials (RCTs), two observational analyses of RCTs and seven observational studies.
Pretreatment was defined as clopidogrel before PCI or catheterization with a loading dose of more than 300 mg or a maintenance dose of 75 mg or more when given for more than 5 days before the procedure.
Clopidogrel pretreatment was associated with a lower risk for major cardiac events (9.83% vs. 12.35%; OR=0.77; 95% CI, 0.66-0.89), the study’s secondary endpoint; however, pretreatment did not lower all-cause mortality, the primary efficacy endpoint, in RCTs (absolute risk, 1.54% vs. 1.97%; OR=0.80; 95% CI, 0.57-1.11). There was also no significant association between pretreatment and major bleeding (3.57% vs. 3.08%; OR=1.18; 95% CI, 0.93-1.5), the study’s primary safety endpoint.
“This meta-analysis demonstrated, however, a significant association between clopidogrel pretreatment and the reduction of major coronary events or MIs in the primary RCTs analyses combining all types of patients, with fully consistent results obtained from observational analyses of RCTs and observational studies,” researchers wrote. “In contrast, patients undergoing elective PCI had no apparent benefit from clopidogrel pretreatment, questioning the need of such a systematic strategy at least in low-risk patients.”
Disclosure: Bellemain-Appaix has received research grants from Daiichi-Sankyo, Eli Lilly, Fédération Française de Cardiologie and Société Française de Cardiologie, and lecture fees from AstraZeneca.