Abstract 16391: The Impact of Smoking on Clinical Outcomes and the Role of Double-Dose versus Standard-Dose Clopidogrel Among Individuals With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention - Insights From the CURRENT-OASIS 7 Trial
Introduction: Smoking is associated with worse outcomes after percutaneous coronary interventions (PCI). It remains unknown if double-dose clopidogrel mitigates this risk in smokers with acute coronary syndromes (ACS) and treated with PCI.
Methods: We analyzed 17263 ACS patients with early PCI enrolled into the multinational CURRENT-OASIS 7 trial, which compared double-dose (600mg on day 1, 150mg on days 2-7 then 75mg daily) vs standard-dose (300mg on day 1 then 75mg daily) clopidogrel in ACS patients. Interaction tests between treatment allocation and smoking status (current vs non-smoker) were performed. The primary outcome (cardiovascular death, myocardial infarction, or stroke at 30 days) was evaluated in smokers and non-smokers.
Results: Overall, 6394 patients (37%) were current smokers. Smokers were younger (55 vs 65 years), predominately male (84% vs 70%), and had more STEMIs (45% vs 32%), p for all <0.0001. The primary endpoint and major bleeding rates differed between smokers and non-smokers (interaction p=0.04 and p=0.001, respectively). In smokers, double-dose clopidogrel reduced the rate of primary outcome (82 events [1.3%] vs 122 events [1.9%]; Hazard ratio (HR) 0.66; 95% CI 0.50-0.88, p=0.004), and the rate of definite stent thrombosis (ST) (18 [0.3%] vs 44 [0.7%]; HR, 0.41; 95% CI [0.23-0.70], P=0.001). In non-smokers, the rate of primary outcome did not differ between the clopidogrel groups (4.6% vs 4.9%, p=0.47), but a higher dose was associated with lower rates of ST (0.8% vs 1.2%, 95% CI 0.42-0.92, P=0.018). Among smokers, there was no difference in major bleeding (31 [0.5%] vs 40 [0.63%], p=0.27), whereas in non-smokers, double-dose clopidogrel increased major bleeding (107 [0.99%] vs 59 [0.54%]; p<0.0001).
Conclusions: In smokers, a double-dose clopidogrel regimen reduced major cardiovascular events and ST after PCI, with no increase in major bleeding. This suggests that more intensive antiplatelet therapy may be justified in those patients.
Author Disclosures: M. Bossard: None. D. Al Khdair: None. D.P. Faxon: None. C.B. Granger: Other Research Support; Modest; Duke University, Sanofi Aventis, Bristol Myers Squibb. Honoraria; Modest; Sanofi Aventis, Bristol Myers Squibb. Consultant/Advisory Board; Modest; Sanofi Aventis, Bristol Myers Squibb. S. Jolly: Speakers Bureau; Modest; Astra Zeneca. M. Natarajan: None. J. Tanguay: None. G. Steg: Other; Significant; All conflicts of interest are listed under www.fact-trials.eu. G. Montalescot: Other; Significant; All conflicts of interest are listed under www.action-coeur.org .. P. Widimsky: None. K. Niemela: None. P. Gao: None. K.A. Fox: Honoraria; Significant; Sanofi-Aventis. S. Yusuf: Research Grant; Significant; Sanofi-Aventis, Bristol Myers Squibb, GlaxoSmithKline, AstraZeneca, Boehringer- Ingelheim. Honoraria; Modest; Sanofi-Aventis, Bristol Myers Squibb, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline. Consultant/Advisory Board; Modest; Sanofi Aventis, Bristol Myers Squibb, AstraZeneca, Boehringer-Ingelheim. S.R. Mehta: Research Grant; Modest; Bristol-Myers-Squibb, Sanofi-Aventis. Research Grant; Significant; AstraZeneca, Boston Scientific. Speakers Bureau; Modest; Astra Zeneca, Sanofi-Aventis. Consultant/Advisory Board; Modest; Sanofi-Aventis. Other; Significant; The CURRENT-OASIS 7 Trial was an investigator driven trial, supported by Sanofi-Aventis and Bristol-Myers Squibb, The trial was coordinated by the investigators at PHRI at McMaster University..
- © 2016 by American Heart Association, Inc.