Featured Research

from universities, journals, and other organizations

Administration of clopidogrel prior to PCI associated with reduction in major cardiac events

Date:
December 18, 2012
Source:
American Medical Association (AMA)
Summary:
Among patients scheduled for a percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries), pretreatment with the antiplatelet agent clopidogrel was not associated with a lower risk of overall mortality but was associated with a significantly lower risk of major coronary events

Among patients scheduled for a percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries), pretreatment with the antiplatelet agent clopidogrel was not associated with a lower risk of overall mortality but was associated with a significantly lower risk of major coronary events, according to a review and meta-analysis of previous studies published in the December 19 issue of JAMA.

Related Articles


"In addition to aspirin, clopidogrel has been shown to improve ischemic outcomes of patients with stable coronary artery disease following PCI and of patients with acute coronary syndromes (ACS; such as heart attack or unstable angina) who were either medically treated or who had undergone either revascularization by fibrinolysis or PCI," according to background information on the article. "Clopidogrel pretreatment is recommended for patients with ACS and stable coronary artery disease who are scheduled for PCI, but whether using clopidogrel as a pretreatment for PCI is associated with positive clinical outcomes has not been established."

Anne Bellemain-Appaix, M.D., of the Service de Cardiologie-La Fontonne Hospital, Antibes, France, and colleagues conducted a review and meta-analysis of data from randomized trials and registries involving patients with coronary artery disease (stable or with ACS) undergoing catheterization for potential revascularization to evaluate the association between clopidogrel pretreatment with mortality and major bleeding after PCI. After a search of the medical literature, the researchers identified 15 articles published between August 2001 and September 2012 that met the study inclusion criteria: 6 randomized controlled trials (RCTs), 2 observational analyses of RCTs, and 7 observational studies. Pretreatment was defined as the administration of clopidogrel before PCI or catheterization. The primary efficacy and safety end points were all-cause mortality and major bleeding. Secondary end points included major cardiac events.

Of the 37,814 patients included in the meta-analysis, 8,608 patients had participated in RCTs; 10,945 in observational analyses of RCTs; and 18,261 in observational studies. In the RCT cohort of patients, clopidogrel pretreatment was not significantly associated with a reduction of all-cause mortality (absolute risk, 1.54 percent vs. 1.97 percent). These results were consistent across the observational analyses of RCTs and the observational studies analyses. Clopidogrel pretreatment was also not associated with a significantly increased risk of major bleeding in the main analysis of RCTs (absolute risk, 3.57 percent vs. 3.08 percent).

In the main analysis, clopidogrel pretreatment was significantly associated with a reduction of major coronary events (absolute risk, 9.83 percent vs. 12.35 percent) and heart attack (absolute risk, 4.53 percent vs. 5.90 percent).

The authors note that although no significant heterogeneity existed for clinical presentation, the higher-risk ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack) population appeared to gain the most benefit from pretreatment. "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."

"Although a pretreatment strategy has been recommended for years in patients undergoing PCI, this study shows the limits of the available evidence, with no significant benefit on hard outcomes. The value of pretreatment, including with new antiplatelet agents, needs to be assessed in large prospective studies."


Story Source:

The above story is based on materials provided by American Medical Association (AMA). Note: Materials may be edited for content and length.


Journal Reference:

  1. Bellemain-Appaix A, O’Connor SA, Silvain J, et al. Association of Clopidogrel Pretreatment With Mortality, Cardiovascular Events, and Major Bleeding Among Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis. JAMA, 2012; 308 (23): 2507-2516 DOI: 10.1001/jama.2012.50788

Cite This Page:

American Medical Association (AMA). "Administration of clopidogrel prior to PCI associated with reduction in major cardiac events." ScienceDaily. ScienceDaily, 18 December 2012. <www.sciencedaily.com/releases/2012/12/121218161758.htm>.
American Medical Association (AMA). (2012, December 18). Administration of clopidogrel prior to PCI associated with reduction in major cardiac events. ScienceDaily. Retrieved November 28, 2014 from www.sciencedaily.com/releases/2012/12/121218161758.htm
American Medical Association (AMA). "Administration of clopidogrel prior to PCI associated with reduction in major cardiac events." ScienceDaily. www.sciencedaily.com/releases/2012/12/121218161758.htm (accessed November 28, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Friday, November 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Rural India's Low-Cost Sanitary Pad Revolution

Rural India's Low-Cost Sanitary Pad Revolution

AFP (Nov. 28, 2014) — One man hopes his invention -– a machine that produces cheap sanitary pads –- will help empower Indian women. Duration: 01:51 Video provided by AFP
Powered by NewsLook.com
Research on Bats Could Help Develop Drugs Against Ebola

Research on Bats Could Help Develop Drugs Against Ebola

AFP (Nov. 28, 2014) — In Africa's only biosafety level 4 laboratory, scientists have been carrying out experiments on bats to understand how virus like Ebola are being transmitted, and how some of them resist to it. Duration: 01:18 Video provided by AFP
Powered by NewsLook.com
Ebola Leaves Orphans Alone in Sierra Leone

Ebola Leaves Orphans Alone in Sierra Leone

AFP (Nov. 27, 2014) — The Ebola epidemic sweeping Sierra Leone is having a profound effect on the country's children, many of whom have been left without any family members to support them. Duration: 01:02 Video provided by AFP
Powered by NewsLook.com
Experimental Ebola Vaccine Shows Promise In Human Trial

Experimental Ebola Vaccine Shows Promise In Human Trial

Newsy (Nov. 27, 2014) — A recent test of a prototype Ebola vaccine generated an immune response to the disease in subjects. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins