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Effect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Koul, Sasha LU ; Smith, Gustav LU ; Scherstén, Fredrik LU ; James, Stefan; Lagerqvist, Bo and Erlinge, David LU (2011) In European Heart Journal 32. p.2990-2998
Abstract
Aims Immediate treatment with a loading dose of clopidogrel at diagnosis of ST-segment elevation myocardial infarction (STEMI) is recommended by ESC/AHA/ACC guidelines in patients eligible for primary percutaneous coronary intervention (PCI). However, the evidence for this practice is scarce. Methods and results All patients who underwent PCI for STEMI in Sweden between 2003 and 2008 were identified from the national Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Patients with concomitant warfarin treatment and patients not having received aspirin upstream were excluded, leaving 13 847 patients for the analysis. Groups were compared for death and myocardial infarction (MI) during 1-year of follow-up using Cox regression... (More)
Aims Immediate treatment with a loading dose of clopidogrel at diagnosis of ST-segment elevation myocardial infarction (STEMI) is recommended by ESC/AHA/ACC guidelines in patients eligible for primary percutaneous coronary intervention (PCI). However, the evidence for this practice is scarce. Methods and results All patients who underwent PCI for STEMI in Sweden between 2003 and 2008 were identified from the national Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Patients with concomitant warfarin treatment and patients not having received aspirin upstream were excluded, leaving 13 847 patients for the analysis. Groups were compared for death and myocardial infarction (MI) during 1-year of follow-up using Cox regression models with adjustment for differences in baseline characteristics by propensity score methods. The combined primary endpoint of death or MI during 1-year follow-up occurred in 1325 of 9813 patients with upstream clopidogrel and in 364 out of 4034 patients without upstream treatment. After propensity score adjustment, a significant relative risk reduction (HR 0.82, 95% CI 0.73-0.93) in death/MI at 1 year was observed. The secondary endpoint of total 1-year death was significantly reduced (HR 0.76, 95% CI: 0.64-0.90), while the incidence of 1-year MI did not show any significant reduction (HR 0.90, 95% CI 0.77-1.06). Similar results were observed in multivariate analysis on top of propensity scoring and in sensitivity analyses excluding patients without clopidogrel and aspirin at discharge. Conclusion This large observational study suggests that upstream clopidogrel treatment prior to arrival at the catheterization lab is associated with a reduction in the combined risk of death or MI as well as death alone in patients with STEMI treated with primary PCI. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Heart Journal
volume
32
pages
2990 - 2998
publisher
Oxford University Press
external identifiers
  • WOS:000297647400014
  • PMID:21719452
  • Scopus:82955194859
ISSN
1522-9645
DOI
10.1093/eurheartj/ehr202
language
English
LU publication?
yes
id
610609ca-c26b-4d6d-8b14-13d828839213 (old id 2059201)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21719452?dopt=Abstract
date added to LUP
2011-08-01 18:34:03
date last changed
2016-10-23 04:32:33
@misc{610609ca-c26b-4d6d-8b14-13d828839213,
  abstract     = {Aims Immediate treatment with a loading dose of clopidogrel at diagnosis of ST-segment elevation myocardial infarction (STEMI) is recommended by ESC/AHA/ACC guidelines in patients eligible for primary percutaneous coronary intervention (PCI). However, the evidence for this practice is scarce. Methods and results All patients who underwent PCI for STEMI in Sweden between 2003 and 2008 were identified from the national Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Patients with concomitant warfarin treatment and patients not having received aspirin upstream were excluded, leaving 13 847 patients for the analysis. Groups were compared for death and myocardial infarction (MI) during 1-year of follow-up using Cox regression models with adjustment for differences in baseline characteristics by propensity score methods. The combined primary endpoint of death or MI during 1-year follow-up occurred in 1325 of 9813 patients with upstream clopidogrel and in 364 out of 4034 patients without upstream treatment. After propensity score adjustment, a significant relative risk reduction (HR 0.82, 95% CI 0.73-0.93) in death/MI at 1 year was observed. The secondary endpoint of total 1-year death was significantly reduced (HR 0.76, 95% CI: 0.64-0.90), while the incidence of 1-year MI did not show any significant reduction (HR 0.90, 95% CI 0.77-1.06). Similar results were observed in multivariate analysis on top of propensity scoring and in sensitivity analyses excluding patients without clopidogrel and aspirin at discharge. Conclusion This large observational study suggests that upstream clopidogrel treatment prior to arrival at the catheterization lab is associated with a reduction in the combined risk of death or MI as well as death alone in patients with STEMI treated with primary PCI.},
  author       = {Koul, Sasha and Smith, Gustav and Scherstén, Fredrik and James, Stefan and Lagerqvist, Bo and Erlinge, David},
  issn         = {1522-9645},
  language     = {eng},
  pages        = {2990--2998},
  publisher    = {ARRAY(0x92c9610)},
  series       = {European Heart Journal},
  title        = {Effect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehr202},
  volume       = {32},
  year         = {2011},
}