Clinical Question: Does treatment with clopidogrel (Plavix) before percutaneous coronary intervention reduce cardiovascular disease (CVD) complications?

Setting: Inpatient (any location) with out-patient follow-up

Study Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: The benefit of clopidogrel treatment before percutaneous coronary intervention remains uncertain. The investigators randomized (uncertain allocation concealment) 1,863 patients with recent ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention to receive aspirin and clopidogrel (300-mg loading dose, then 75 mg once daily) or matched placebo before angiography. All patients undergoing coronary artery stenting received clopidogrel after diagnostic angiography. Researchers blinded to treatment group assignment assessed outcomes. Follow-up occurred for nearly 100 percent of patients. Using intention-to-treat analysis, pretreatment with clopidogrel significantly reduced the composite outcome of cardiovascular death, recurrent myocardial infarction, or stroke at 30 days of monitoring (number needed to treat = 22; 95% confidence interval, 14 to 54). Bleeding complications occurred at a similar rate in each treatment group.

Bottom Line: Treatment with clopidogrel before percutaneous coronary intervention reduces the risk of cardiovascular disease complications without increasing the risk of bleeding complications. This study only monitored patients for 30 days after the intervention, so further long-term studies are needed before a general recommendation can be made. (Level of Evidence: 1b–)