Blog | Friday, December 21, 2012

QD: News Every Day--Clopidogrel pretreatment for PCI may not lower mortality risk


Clopidogrel pretreatment was not associated with a lower risk of mortality but was associated with a lower risk of major coronary events among patients scheduled for percutaneous coronary intervention (PCI), according to a meta-analysis of more than 37,000 patients.

Researchers reviewed six randomized controlled trials published between August 2001 and September 2012. They then conducted a confirmatory analysis of two observational reports of randomized, controlled trials and an analysis of seven observational studies.

Results appeared in the Journal of the American Medical Association.

Among more than 8,600 patients in the randomized, controlled trials, clopidogrel pretreatment was not significantly associated with a reduction of all-cause mortality (absolute risk, 1.54% vs. 1.97%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.57-1.11; P=.17). Observational analyses of randomized, controlled trials and of the observational studies confirmed these results.

Among randomized, controlled trials that reviewed mortality data, the association between clopidogrel pretreatment and reduction of cardiovascular death was not present (absolute risk, 1.54% vs. 1.97%; OR, 0.78; 95% CI, 0.44-1.39; P=.41). One observational study had consistent results with this (absolute risk, 1.44% vs 1.92%; OR, 0.80; 95% CI, 0.57-1.11; P=.17).

Researchers noted that clopidogrel pretreatment was not associated with a higher risk of major bleeding among the randomized, controlled trials (absolute risk, 3.57% vs. 3.08%; OR, 1.18; 95% CI, 0.93-1.50; P=.18), and that these results were also confirmed among the observational analyses of randomized, controlled trials and a pooled analysis of observational studies.

Researchers wrote, "This meta-analysis demonstrated, however, a significant association between clopidogrel pretreatment and the reduction of major coronary events or (myocardial infarctions) MIs in the primary (randomized, controlled trials) RCTs analyses combining all types of patients, with fully consistent results obtained from observational analyses of RCTs and observational studies. Although no significant heterogeneity existed for clinical presentation, the higher-risk (ST-elevated myocardial infarction) STEMI population appeared to gain the most benefit from pretreatment."

Editor's Note: QD--News Every Day will resume Jan. 2.