title: Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.
abstract: BACKGROUND
  Despite the use of aspirin, there is still a risk of ischaemic events after percutaneous coronary intervention (PCI). We aimed to find out whether, in addition to aspirin, pretreatment with clopidogrel followed by long-term therapy after PCI is superior to a strategy of no pretreatment and short-term therapy for only 4 weeks after PCI.
  
  
  METHODS
  2658 patients with non-ST-elevation acute coronary syndrome undergoing PCI in the CURE study had been randomly assigned double-blind treatment with clopidogrel (n=1313) or placebo (n=1345). Patients were pretreated with aspirin and study drug for a median of 6 days before PCI during the initial hospital admission, and for a median of 10 days overall. After PCI, most patients (>80%) in both groups received open-label thienopyridine for about 4 weeks, after which study drug was restarted for a mean of 8 months. The primary endpoint was a composite of cardiovascular death, myocardial infarction, or urgent target-vessel revascularisation within 30 days of PCI. The main analysis was by intention to treat.
  
  
  RESULTS
  There were no drop-outs. 59 (4.5%) patients in the clopidogrel group had the primary endpoint, compared with 86 (6.4%) in the placebo group (relative risk 0.70 [95% CI 0.50-0.97], p=0.03). Long-term administration of clopidogrel after PCI was associated with a lower rate of cardiovascular death, myocardial infarction, or any revascularisation (p=0.03), and of cardiovascular death or myocardial infarction (p=0.047). Overall (including events before and after PCI) there was a 31% reduction cardiovascular death or myocardial infarction (p=0.002). There was less use of glycoprotein IIb/IIIa inhibitor in the clopidogrel group (p=0.001). At follow-up, there was no significant difference in major bleeding between the groups (p=0.64).
  
  
  CONCLUSIONS
  In patients with acute coronary syndrome receiving aspirin, a strategy of clopidogrel pretreatment followed by long-term therapy is beneficial in reducing major cardiovascular events, compared with placebo.
authors.affiliation: Division of Cardiology, the Population Health Research Institute and the Canadian Cardiovascular Collaboration Project Office, McMaster University, Hamilton, Canada. smehta@mcmaster.ca
authors.forename: S R
authors.initials: SR
authors.lastname: Mehta
authors.forename: S
authors.initials: S
authors.lastname: Yusuf
authors.forename: R J
authors.initials: RJ
authors.lastname: Peters
authors.forename: M E
authors.initials: ME
authors.lastname: Bertrand
authors.forename: B S
authors.initials: BS
authors.lastname: Lewis
authors.forename: M K
authors.initials: MK
authors.lastname: Natarajan
authors.forename: K
authors.initials: K
authors.lastname: Malmberg
authors.forename: H
authors.initials: H
authors.lastname: Rupprecht
authors.forename: F
authors.initials: F
authors.lastname: Zhao
authors.forename: S
authors.initials: S
authors.lastname: Chrolavicius
authors.forename: I
authors.initials: I
authors.lastname: Copland
authors.forename: K A
authors.initials: KA
authors.lastname: Fox
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011300:Preoperative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D016019:Survival Analysis; D013988:Ticlopidine / Q000008:administration & dosage* / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin