This Article Full Text Full Text (PDF) All Versions of this Article: 118/18/1828    most recent CIRCULATIONAHA.107.749531v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vlaar, P. J. Articles by Zijlstra, F. Search for Related Content PubMed PubMed Citation Articles by Vlaar, P. J. Articles by Zijlstra, F. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Angioplasty Blood Thinners Heart Attack Related Collections Platelet function inhibitors Catheter-based coronary and valvular interventions: other Acute myocardial infarction Related Article

(Circulation. 2008;118:1828-1836.)
© 2008 American Heart Association, Inc.

Interventional Cardiology

Impact of Pretreatment With Clopidogrel on Initial Patency and Outcome in Patients Treated With Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

A Systematic Review

Pieter J. Vlaar, MSc; Tone Svilaas, MD; Kevin Damman, MD; Bart J.G.L. de Smet, MD, PhD; Jan G.P. Tijssen, MD, PhD; Hans L. Hillege, MD, PhD; Felix Zijlstra, MD, PhD

From the University Medical Center Groningen, University of Groningen, Thorax Center, Departments of Cardiology (P.J.V., T.S., K.D., B.J.G.L.d.S., H.L.H., F.Z.) and Epidemiology (H.L.H.), Groningen, and Academic Medical Center, University of Amsterdam, Department of Cardiology, Amsterdam (J.G.P.T.), the Netherlands.

Correspondence to P.J. Vlaar, Thorax Center, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. E-mail p.j.j.vlaar{at}thorax.umcg.nl

Received October 31, 2007; accepted August 20, 2008.

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.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2008 118: 1777-1778. [Extract] [Full Text]

This article has been cited by other articles:

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 2, 2009; 53(22): 2080 - 2097. [Full Text] [PDF]