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• W4376848313 abstract "Background Despite the use of aspirin, there is still a risk of ischaemic events after percutaneous coronary intervention (PCI). We aimed to find out whether, in addition to aspirin, pretreatment with clopidogrel followed by long-term therapy after PCI is superior to a strategy of no pretreatment and short-term therapy for only 4 weeks after PCI. Methods 2658 patients with non-ST-elevation acute coronary syndrome undergoing PCI in the CURE study had been randomly assigned double-blind treatment with clopidogrel (n=1313) or placebo (n=1345). Patients were pretreated with aspirin and study drug for a median of 6 days before PCI during the initial hospital admission, and for a median of 10 days overall. After PCI, most patients (>80%) in both groups received open-label thienopyridine for about 4 weeks, after which study drug was restarted for a mean of 8 months. The primary endpoint was a composite of cardiovascular death, myocardial infarction, or urgent target-vessel revascularisation within 30 days of PCI. The main analysis was by intention to treat. Findings There were no drop-outs. 59 (4·5%) patients in the clopidogrel group had the primary endpoint, compared with 86 (6·4%) in the placebo group (relative risk 0·70 [95% CI 0·50–0·97], p=0·03). Long-term administration of clopidogrel after PCI was associated with a lower rate of cardiovascular death, myocardial infarction, or any revascularisation (p=0·03), and of cardiovascular death or myocardial infarction (p=0·047). Overall (including events before and after PCI) there was a 31% reduction cardiovascular death or myocardial infarction (p=0·002). There was less use of glycoprotein IIb/IIIa inhibitor in the clopidogrel group (p=0·001). At follow-up, there was no significant difference in major bleeding between the groups (p=0·64). Interpretation In patients with acute coronary syndrome receiving aspirin, a strategy of clopidogrel pretreatment followed by long-term therapy is beneficial in reducing major cardiovascular events, compared with placebo. Despite the use of aspirin, there is still a risk of ischaemic events after percutaneous coronary intervention (PCI). We aimed to find out whether, in addition to aspirin, pretreatment with clopidogrel followed by long-term therapy after PCI is superior to a strategy of no pretreatment and short-term therapy for only 4 weeks after PCI. 2658 patients with non-ST-elevation acute coronary syndrome undergoing PCI in the CURE study had been randomly assigned double-blind treatment with clopidogrel (n=1313) or placebo (n=1345). Patients were pretreated with aspirin and study drug for a median of 6 days before PCI during the initial hospital admission, and for a median of 10 days overall. After PCI, most patients (>80%) in both groups received open-label thienopyridine for about 4 weeks, after which study drug was restarted for a mean of 8 months. The primary endpoint was a composite of cardiovascular death, myocardial infarction, or urgent target-vessel revascularisation within 30 days of PCI. The main analysis was by intention to treat. There were no drop-outs. 59 (4·5%) patients in the clopidogrel group had the primary endpoint, compared with 86 (6·4%) in the placebo group (relative risk 0·70 [95% CI 0·50–0·97], p=0·03). Long-term administration of clopidogrel after PCI was associated with a lower rate of cardiovascular death, myocardial infarction, or any revascularisation (p=0·03), and of cardiovascular death or myocardial infarction (p=0·047). Overall (including events before and after PCI) there was a 31% reduction cardiovascular death or myocardial infarction (p=0·002). There was less use of glycoprotein IIb/IIIa inhibitor in the clopidogrel group (p=0·001). At follow-up, there was no significant difference in major bleeding between the groups (p=0·64). In patients with acute coronary syndrome receiving aspirin, a strategy of clopidogrel pretreatment followed by long-term therapy is beneficial in reducing major cardiovascular events, compared with placebo. Clopidogrel in invasive management of non-ST-elevation ACSMany patients presenting with an acute coronary syndrome (ACS) are managed conservatively.1 The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial (CURE) has examined whether the addition of clopidogrel improves outcomes in this setting.2 More than 12 500 patients presenting with non-ST-elevation ACS were recruited for this prospective, placebo-controlled, randomised trial. Clopidogrel (or matching placebo) was given orally in an immediate loading bolus of 300 mg, followed by a maintenance dose of 75 mg once a day. Full-Text PDF" @default.
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• W4376848313 date "2001-08-01" @default.
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• W4376848313 title "Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study" @default.
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• W4376848313 doi "https://doi.org/10.1016/s0140-6736(01)05701-4" @default.
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