Clopidogrel pre-treatment in stable angina: for all patients > 6 h before elective coronary angiography or only for angiographically selected patients a few minutes before PCI? A randomized multicentre trial PRAGUE-8.
OBJECTIVE
To compare two different clopidogrel regimens on the outcomes of patients undergoing elective coronary angiography (CAG)+/-ad hoc percutaneous coronary intervention (PCI).


RESULTS
Open-trial randomized 1028 patients with stable angina to group A ('non-selective'-clopidogrel 600 mg > 6 h before CAG; n = 513) or group B ('selective'-clopidogrel 600 mg in the cath-lab after CAG, only in case of PCI; n = 515). Combined primary endpoint was death/periprocedural myocardial infarction (MI)/stroke/re-intervention within 7 days. Secondary endpoints were troponin elevation and bleeding complications. Primary endpoint occurred in 0.8% group A patients vs. 1% group B (P = 0.749; 90% CI for the percentage difference -1.2-0.8). Periprocedural troponin elevation (> 3 x ULN) was detected in 2.6% group A vs. 3.3% group B (P = 0.475; 90% CI -2.5-1.0). Bleeding complications occurred in 3.5% group A patients vs. 1.4% group B (P = 0.025). After adjustment for covariates and factors that may influence the bleeding risk, patients in group A were shown to have more likely bleeding complications when compared with group B (OR = 3.03; 95% CI 1.14-8.10; P = 0.027).


CONCLUSIONS
High (600 mg) loading dose of clopidogrel before elective CAG increased the risk of minor bleeding complications, while the benefit on periprocedural infarction was not significant. Clopidogrel can be given safely in the catheterization laboratory between CAG and PCI in chronic stable angina patients.
Widimsky
Petr
P
Third Medical Faculty and University Hospital Kralovske Vinohrady, Cardiocentre, Charles University, Srobárova 50, 10034 Praha 10, Prague, Czech Republic. widim@fnkv.cz
Motovská
Zuzana
Z
Simek
Stanislav
S
Kala
Petr
P
Pudil
Radek
R
Holm
Frantisek
F
Petr
Robert
R
Bílková
Dana
D
Skalická
Hana
H
Kuchynka
Petr
P
Poloczek
Martin
M
Miklík
Roman
R
Maly
Marek
M
Aschermann
Michael
M
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D016063:Blood Loss, Surgical; D002908:Chronic Disease; D000077144:Clopidogrel; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011292:Premedication; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014336:Troponin / Q000378:metabolism
D010975:Platelet Aggregation Inhibitors; D014336:Troponin; D000077144:Clopidogrel; D013988:Ticlopidine