BACKGROUND: The main goal of the initial treatment of ST-segment elevation myocardial infarction is prompt reperfusion of the infarct-related artery. The value of pretreatment with clopidogrel before primary percutaneous coronary intervention is currently unclear. METHODS AND RESULTS: Studies were retrieved through MEDLINE and Cochrane Controlled Trials Register searches over the past 20 years. Two authors independently performed the study selection and data extraction. Randomized controlled studies were included when the research subjects were unselected patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Pilot trials, studies that enrolled patients undergoing rescue percutaneous coronary intervention, and studies with angiographic assessment not performed by a core laboratory or 2 blinded investigators were excluded. Thirty-eight treatment groups, including 8429 patients, were included. Initial patency was higher in treatment groups in which patients received pretreatment with clopidogrel (34.3%; 95% confidence interval, 32.9 to 35.8) compared with those in which patients did not receive clopidogrel before initial coronary angiography (25.8%; 95% confidence interval, 24.5 to 27.1). In multivariate-weighted logistic regression analysis, pretreatment with clopidogrel was an independent predictor of early reperfusion (odds ratio, 1.51; 95% confidence interval, 1.31 to 1.74; P<0.0001) and improved clinical outcome. CONCLUSIONS: Initial patency and clinical outcome were improved in treatment groups that received pretreatment with clopidogrel. These results in patients undergoing primary percutaneous coronary intervention are in line with the experience of pretreatment with clopidogrel in elective patients, non-ST-elevation coronary syndromes, and thrombolytic studies.
BACKGROUND: The main goal of the initial treatment of ST-segment elevation myocardial infarction is prompt reperfusion of the infarct-related artery. The value of pretreatment with clopidogrel before primary percutaneous coronary intervention is currently unclear. METHODS AND RESULTS: Studies were retrieved through MEDLINE and Cochrane Controlled Trials Register searches over the past 20 years. Two authors independently performed the study selection and data extraction. Randomized controlled studies were included when the research subjects were unselected patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Pilot trials, studies that enrolled patients undergoing rescue percutaneous coronary intervention, and studies with angiographic assessment not performed by a core laboratory or 2 blinded investigators were excluded. Thirty-eight treatment groups, including 8429 patients, were included. Initial patency was higher in treatment groups in which patients received pretreatment with clopidogrel (34.3%; 95% confidence interval, 32.9 to 35.8) compared with those in which patients did not receive clopidogrel before initial coronary angiography (25.8%; 95% confidence interval, 24.5 to 27.1). In multivariate-weighted logistic regression analysis, pretreatment with clopidogrel was an independent predictor of early reperfusion (odds ratio, 1.51; 95% confidence interval, 1.31 to 1.74; P<0.0001) and improved clinical outcome. CONCLUSIONS: Initial patency and clinical outcome were improved in treatment groups that received pretreatment with clopidogrel. These results in patients undergoing primary percutaneous coronary intervention are in line with the experience of pretreatment with clopidogrel in elective patients, non-ST-elevation coronary syndromes, and thrombolytic studies.
Authors: Dariusz Dudek; Tomasz Rakowski; Stanislaw Bartus; Dawid Giszterowicz; Wojciech Dobrowolski; Krzysztof Zmudka; Jaroslaw Zalewski; Andrzej Ochala; Pawel Wieja; Bogdan Janus; Artur Dziewierz; Jacek Legutko; Leszek Bryniarski; Jacek S Dubiel Journal: J Thromb Thrombolysis Date: 2010-10 Impact factor: 2.300
Authors: Rodrigo Estévez-Loureiro; Angela López-Sainz; Armando Pérez de Prado; Carlos Cuellas; Ramón Calviño Santos; Norberto Alonso-Orcajo; Jorge Salgado Fernández; Jose Manuel Vázquez-Rodríguez; Maria López-Benito; Felipe Fernández-Vázquez Journal: World J Cardiol Date: 2014-06-26
Authors: Sasha Koul; Pontus Andell; Andreas Martinsson; J Gustav Smith; Fredrik Scherstén; Jan Harnek; Matthias Götberg; Eva Norström; Sven Björnsson; David Erlinge Journal: BMC Cardiovasc Disord Date: 2014-12-16 Impact factor: 2.298
Authors: Leonardo De Luca; Furio Colivicchi; Michele Massimo Gulizia; Francesco Rocco Pugliese; Maria Pia Ruggieri; Giuseppe Musumeci; Gian Alfonso Cibinel; Francesco Romeo Journal: Eur Heart J Suppl Date: 2017-05-02 Impact factor: 1.803