Extracardiac vascular disease and effectiveness of sustained clopidogrel treatment.
OBJECTIVE
To assess the effectiveness of long term treatment with clopidogrel of patients with extracardiac vascular disease (ECVD) (a history of either peripheral arterial disease or cerebrovascular disease).


METHODS
Subgroup analysis of a prospective randomised clinical trial.


METHODS
The CREDO (clopidogrel for the reduction of events during observation) trial was a randomised, double blind, placebo controlled trial conducted at 99 centres in North America from June 1999 through April 2001.


METHODS
2116 patients who were to undergo elective coronary intervention or were deemed at high likelihood of undergoing percutaneous coronary intervention were enrolled in the CREDO trial. The current study sample consisted of 272 patients with ECVD.


METHODS
One year incidence of the composite of death, myocardial infarction, or stroke in the intent to treat population.


RESULTS
Patients with ECVD had a more than twofold greater relative risk reduction with clopidogrel for the primary end point compared with patients without ECVD (47.9%, 95% confidence interval (CI) -4.2% to 73.9%, v 18.2%, 95% CI -10.5 % to 39.5%, respectively).


CONCLUSIONS
Longer term clopidogrel treatment provides added protection against thrombotic events throughout the arterial vasculature, not limited to the coronary arteries, and may be especially effective for patients with more diffuse atherosclerosis such as ECVD.
Mukherjee
D
D
Division of Cardiovascular Medicine, The Gill Heart Institute, Lexington, Kentucky 40536-0200, USA. Mukherjee@uky.edu
Topol
E J
EJ
Moliterno
D J
DJ
Brennan
D M
DM
Ziada
K
K
Cho
L
L
Steinhubl
S R
SR
D000368:Aged; D002561:Cerebrovascular Disorders / Q000401:mortality / Q000517:prevention & control*; D000077144:Clopidogrel; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine