Prognostic impact of clopidogrel pretreatment in patients with acute coronary syndrome managed invasively

The American Journal of Cardiology
Manuel Almendro-DeliaARIAM-Andalucía Group

Abstract

Pretreatment with antiP2Y12 agents before angiography in acute coronary syndrome (ACS) is associated with a reduction in thrombotic events. However, recent evidences have questioned the benefits of upstream antiP2Y12, reporting a higher incidence of bleeding. We analyzed the prognostic impact of clopidogrel pretreatment in a large cohort of invasively managed patients with ACS. In hospital, safety and efficacy of clopidogrel pretreatment were retrospectively analyzed in patients included in the ARIAM-Andalucía Registry (Analysis of Delay in Acute Myocardial Infarction). Propensity score and inverse probability of treatment weighting analysis were performed to control treatment selection bias. Results were stratified by ACS type. Sensitivity analyses were used to explore stability of the overall treatment effect. Of 9,621 patients managed invasively, 69% received clopidogrel before coronary angiography. In the ST-elevation myocardial infarction group, pretreatment was associated with a significant reduction in reinfarction (odds ratio 0.53, 95% confidence interval [CI] 0.27 to 0.96; p = 0.027), stent thrombosis (odds ratio 0.15, 95% CI 0.06 to 0.38; p <0.0001), and mortality (odds ratio 0.67, 95% CI 0.48 to 0.94; p = 0.020), wit...Continue Reading

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Citations

Sep 1, 2015·European Heart Journal. Acute Cardiovascular Care·Farzin BeyguiUNKNOWN ACCA study group on pre-hospital care
Nov 21, 2020·Journal of the American College of Cardiology·Gilles Montalescot
Nov 20, 2021·JAMA Network Open·Michel Zeitouni, Jean-Philippe Collet

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