Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study

Mehta, Shamir R.; Yusuf, Salim; Peters, Ron J.G.

doi:10.1016/s1062-1458(02)00559-7

Cited by 2,019 publications

(814 citation statements)

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“…At 12 months, clopidogrel plus aspirin was associated with a 20% relative reduction compared with aspirin alone (9.3% vs 11.4%; P = 0.00009) in the primary composite end point of cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke. 20 In PCI-CURE, 21 a prospective subgroup analysis of 2,658 patients from the CURE study who underwent PCI with a bare-metal stent, a 31% relative reduction in the composite end point was reported with clopidogrel plus aspirin compared with aspirin alone (8.8% vs 12.6%; P = 0.002). In the CREDO trial, 22 which involved 2,116 patients undergoing elective PCI, the benefits of a preprocedural loading dose of clopidogrel, and of continuing clopidogrel for 12 months after PCI with a bare-metal stent, both in addition to aspirin therapy, were investigated.…”

Section: Current P2y 12 Inhibitorsmentioning

confidence: 99%

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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| Guideline recommendations on the use of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention (PCI) have been formulated by both the ACC/AHA and the ESC. These recommendations are based primarily on large, phase III, randomized, controlled trials of the P2Y 12 inhibitors clopidogrel, prasugrel, and ticagrelor. However, few East Asian patients have been included in the trials to assess the use of these agents, particularly the newer agents prasugrel and ticagrelor. Additionally, an increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with white patients, and that a different 'therapeutic window' of on-treatment platelet reactivity might be appropriate in East Asian patients. Furthermore, a phenomenon referred to as the 'East Asian paradox' has been described, in which East Asian patients have a similar or even a lower rate of ischaemic events after PCI compared with white patients, despite a higher level of platelet reactivity during DAPT. Recognizing these concerns, the World Heart Federation has undertaken this evidence-based review and produced this expert consensus statement to determine the antiplatelet treatment strategies that are most appropriate for East Asian patients.

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Section: Current P2y 12 Inhibitorsmentioning

confidence: 99%

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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“…In the PCI-Clopidogrel in Unstable Angina to Prevent Recurrent Events (PCI CURE) trial, pretreatment with clopidogrel and aspirin vs aspirin alone, resulted in a significant reduction in cardiovascular death, MI, or the need for urgent revascularization with no significant increase in life threatening bleeding. 10 The Combination Of Maintenance Methotrexate-Infliximab (COMMIT) trial compared aspirin and clopidogrel combined to aspirin alone in patients with STEMI and concluded that clopidogrel significantly reduced death, reinfarction, stroke, and allcause mortality in patients older than 70 years of age. 11…”

Section: Clopidogrelmentioning

confidence: 99%

Acute Coronary Syndrome in the Elderly

Shanmugasundaram

Alpert

2009

Clinical Cardiology

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The spectrum of acute coronary syndrome (ACS) including unstable angina, non–ST‐elevation myocardial infarction and ST‐elevation myocardial infarction accounts for increasing numbers of deaths among persons age ≥ 65 years in the US. This is important given demographic changes involving falling birth rates and increasing life expectancy. Elderly patients are likely to benefit the most from treatment of ACS, even though community practice still demonstrates less use of cardial medications as an early‐invasive approach among this population. Copyright © 2009 Wiley Periodicals, Inc.

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“…2,3 In addition, dual antiplatelet therapy with aspirin and clopidogrel has greatly decreased the risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). 4,5 Although the addition of thienopyridines to aspirin is widely implemented, recurrent thrombotic events and in-stent thrombosis still occur, which are associated with significant mortality and morbidity. 6 -9 These clinical findings have put forward concern about antiplatelet-therapy resistance.…”

Section: Introductionmentioning

confidence: 99%

Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

Wang

Dai-fu

Zhuang

et al. 2011

Clinical Cardiology

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Background: Despite dual antiplatelet therapy, the rate of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) remains high. Ex vivo tests of clopidogrel resistance can predict MACE after PCI. The purpose of this study is to evaluate the clinical impact of adjusting phosphorylation analysis in patients with clopidogrel resistance undergoing PCI. Hypothesis: We hypothesized that VASP-guided clopidogrel maintenance doses, compared to fixed doses, improved clinical outcome. Methods: This monocentric, prospective, randomized study was performed on 306 patients undergoing PCI. Patients were randomized to a control group (n = 156) and to a vasodilator-stimulated phosphoprotein (VASP)-guided group (n = 150). In the VASP-guided group, patients received adjusted maintenance doses of clopidogrel to obtain platelet reactivity index (PRI) of <50% during 1 year after PCI. The primary endpoint was the rate of MACE. The secondary endpoints were major and minor bleeding. Results: All patients completed the PCI procedure and 298 patients completed follow-up. The control and VASP-guided groups had similar demographic, clinical, and angiographic characteristics. In the VASP-guided group, PRI was significantly decreased (from 72.1% ± 11.4% to 27.7% ± 8.4%; P = 0.001) in 128 patients (87.1% of all participants). During the 1-year follow-up, 14 MACEs were recorded in the VASP-guided group and 30 MACEs were recorded in the control group (9.3% vs 20.4%, respectively; P = 0.008). There was no difference in the rate of major and minor bleeding in the VASP-guided group compared with the control group (12.9% vs 16.6%; P = 0.06). Conclusions: Modifying clopidogrel maintenance doses according to platelet reactivity monitoring decreases the rate of MACE after PCI without increasing bleeding in patients with clopidogrel resistance during 1-year follow-up.

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Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study

Cited by 2,019 publications

References 0 publications

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

Acute Coronary Syndrome in the Elderly

Modifying Clopidogrel Maintenance Doses According to Vasodilator‐Stimulated Phosphoprotein Phosphorylation Index Improves Clinical Outcome in Patients With Clopidogrel Resistance

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