Wednesday, July 20, 2011

Clopidogrel therapy Hulu (Upstream) Post-STEMI

The results of a large-scale observational study conducted recently strengthened guidelines updated in Europe and America to recommend the administration of clopidogrel as early as possible post-STEMI (ST-segment elevation myocardial infarction). This finding revealed by dr. David Erlinge and colleagues from Sweden, published in European Heart Journal in early July 2011. These researchers found that clopidogrel therapy upstream (upstream) before patients undergo catheterization associated with a decreased risk of death or myocardial infarction (myocardial infarction, MI) in patients with STEMI who underwent PCI (percutaneous coronary intervention) primer. Clopidogrel, which slow its effects, usually given shortly after the occurrence of STEMI (before primary PCI), although to date there is no definitive evidence regarding this practice.
However, studies conducted by dr. Erlinge and the team gave a strong indication that the upstream clopidogrel therapy beneficial for patients with STEMI.
The research team used data from the National Swedish Coronary Angiography and Angioplasty in order to evaluate the long-term clinical impact of clopidogrel therapy in 13,847 patients with STEMI upstream who underwent primary PCI between 2003 and 2008. Of these, 9813 (71%) patients received clopidogrel therapy before undergoing catheterization upstream, while 4034 (29%) patients did not. To minimize confounding factors (confounding factors), all patients must receive prior aspirin therapy and are not allowed to use warfarin therapy simultaneously.
At follow-up for 1 year, the combined primary endpoint (death or MI) occurred in 1325 patients receiving clopidogrel therapy upstream (14.3%) and in 712 patients who did not receive clopidogrel therapy upstream (17.9%). After adjustment propensity score (propensity score adjustment), clopidogrel therapy is associated with decreased significantly upstream relative risk of death or MI after 30 days (hazard ratio [HR] 0.83) and 1 year (HR 0.82). Both of these results remained significant after additional multivariate adjustment. After 1 year, there were 665 deaths (7.2%) in the clopidogrel group upstream and 376 deaths (9.4%) in the group did not receive clopidogrel therapy upstream. Again, using the method of propensity score adjustment, there was a significantly reduced risk of death after 30 days and 1 year (HR respectively 0.70 and 0.76). The results also persist after multivariate adjustment. During the follow-up, as many as 719 cases of MI occurred in the upstream clopidogrel group (8.2%) and 369 cases of MI in the group who did not receive clopidogrel upstream (9.9%). After propensity score adjustment, there was no difference in trend between the two groups after 30 days (HR 1.00), but there is a trend towards benefit for the upstream clopidogrel group after 1 year (HR 0.90).
"As far as we know, this study represents the largest study ever published on the upstream of clopidogrel therapy in patients with STEMI undergoing primary PCI," said dr. Erlinge. Conclusion, the results of this study support the practice in the field because it shows a real reduction in the number of cardiovascular clinical endpoints, including total mortality.

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