title: Comparison between ticlopidine and clopidogrel in patients undergoing primary stenting in acute myocardial infarction: results from the CADILLAC trial.
abstract: OBJECTIVE
  The aim of this article is to examine whether clopidogrel and ticlopidine treatments produce similar clinical outcomes for patients receiving primary stenting for acute myocardial infarction (AMI).
  
  
  BACKGROUND
  Prior studies have yielded conflicting results on the relative safety and efficacy of clopidogrel and ticlopidine after stent implantation, warranting an evaluation in primary stenting for AMI.
  
  
  METHODS
  In the multicenter, prospective CADILLAC trial, patients undergoing primary infarct stenting were treated at operator discretion with either ticlopidine (931 patients) or clopidogrel (163 patients) and then followed for 1 year. Baseline clinical and angiographic characteristics were comparable except for baseline TIMI 0/1 flow (72.5% clopidogrel vs. 63.9% ticlopidine, P = 0.04).
  
  
  RESULTS
  Patients receiving clopidogrel had more recurrent ischemia in hospital (6.1 vs. 2.8%, P = 0.02) and at 30 days (10.5 vs. 5.8%, P = 0.02), more moderate and severe bleeding at 30 days (7.4 vs. 2.7%, P = 0.002), and similar rates of stent thrombosis out to 1 year (P = 0.11). By multivariable analysis, clopidogrel use was an independent predictor for recurrent ischemia in hospital (P = 0.0002), and at 30 days (P = 0.012); and of moderate and severe bleeding in hospital (P = 0.002), and at 30 days (P = 0.001).
  
  
  CONCLUSIONS
  Despite thienopyridines similarities, their efficacy may be different within the first 30 days of primary stenting for AMI. A prospective, randomized trial is required to confirm these findings.
authors.affiliation: Columbia University Medical Center, Department of Cardiology, Cardiovascular Research Foundation, New York, New York 10022, USA.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tsuchiya
authors.forename: Micheal
authors.initials: M
authors.lastname: Brener
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Ecaterina
authors.initials: E
authors.lastname: Cristea
authors.forename: Cody
authors.initials: C
authors.lastname: Pietras
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: Eulogio
authors.initials: E
authors.lastname: Garcia
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Thomas
authors.initials: T
authors.lastname: Stuckey
authors.forename: Mark
authors.initials: M
authors.lastname: Turco
authors.forename: John D
authors.initials: JD
authors.lastname: Carroll
authors.forename: Barry D
authors.initials: BD
authors.lastname: Rutherford
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Moses
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D005060:Europe; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D017202:Myocardial Ischemia / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D000077284:Abciximab