Do patients undergoing percutaneous coronary intervention benefit from clopidogrel pretreatment?

William S Weintraub

This article has no abstract so we have provided the first paragraph of the full text.

How thoroughly and in what settings should we block platelets before PCI? In the PCI–CLARITY study by Sabatine et al., 1,863 patients with STEMI undergoing thrombolysis followed by PCI were treated with the platelet ADP blocker clopidogrel, or placebo. This PCI–CLARITY study examines a subset of patients undergoing PCI from the larger CLARITY–TIMI 28 study, in which 3,491 patients were randomized to receive clopidogrel or placebo.¹ The PCI–CLARITY study was a postrandomization subgroup analysis, which found that clopidogrel pretreatment reduced the incidence of cardiovascular death, recurrent MI or stroke at 30 days from 12.0% to 7.5% (P = 0.001) without increasing bleeding rates. There was a similar decrease in these events before PCI and from the time of PCI to 30 days. All endpoint components favored clopidogrel treatment and results were good in multiple subgroups, which is remarkable given that virtually all of these patients were expected to take open-label clopidogrel after their PCI procedure. Thus, the PCI–CLARITY study adds to the results of the PCI–CURE study, which showed the benefit of clopidogrel in patients with non-ST-elevation acute coronary syndromes, and the CREDO study, which showed clopidogrel's benefit in patients with stable coronary artery disease.^{2, 3} The large benefit of clopidogrel treatment after just 30 days suggests that its use before PCI in patients with STEMI is almost certainly an effective strategy for improving outcome while lowering cost.

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