Comparison between ticlopidine and clopidogrel in patients undergoing primary stenting in acute myocardial infarction: results from the CADILLAC trial.
Publication/Presentation Date
12-1-2008
Abstract
OBJECTIVE: The aim of this article is to examine whether clopidogrel and ticlopidine treatments produce similar clinical outcomes for patients receiving primary stenting for acute myocardial infarction (AMI).
BACKGROUND: Prior studies have yielded conflicting results on the relative safety and efficacy of clopidogrel and ticlopidine after stent implantation, warranting an evaluation in primary stenting for AMI.
METHODS: In the multicenter, prospective CADILLAC trial, patients undergoing primary infarct stenting were treated at operator discretion with either ticlopidine (931 patients) or clopidogrel (163 patients) and then followed for 1 year. Baseline clinical and angiographic characteristics were comparable except for baseline TIMI 0/1 flow (72.5% clopidogrel vs. 63.9% ticlopidine, P = 0.04).
RESULTS: Patients receiving clopidogrel had more recurrent ischemia in hospital (6.1 vs. 2.8%, P = 0.02) and at 30 days (10.5 vs. 5.8%, P = 0.02), more moderate and severe bleeding at 30 days (7.4 vs. 2.7%, P = 0.002), and similar rates of stent thrombosis out to 1 year (P = 0.11). By multivariable analysis, clopidogrel use was an independent predictor for recurrent ischemia in hospital (P = 0.0002), and at 30 days (P = 0.012); and of moderate and severe bleeding in hospital (P = 0.002), and at 30 days (P = 0.001).
CONCLUSIONS: Despite thienopyridines similarities, their efficacy may be different within the first 30 days of primary stenting for AMI. A prospective, randomized trial is required to confirm these findings.
Volume
72
Issue
7
First Page
917
Last Page
924
ISSN
1522-726X
Published In/Presented At
Lansky, A. J., Tsuchiya, Y., Brener, M., Mehran, R., Cristea, E., Pietras, C., Grines, C. L., Cox, D. A., Garcia, E., Tcheng, J. E., Guagliumi, G., Stuckey, T., Turco, M., Carroll, J. D., Rutherford, B. D., Leon, M. B., Moses, J., & Stone, G. W. (2008). Comparison between ticlopidine and clopidogrel in patients undergoing primary stenting in acute myocardial infarction: results from the CADILLAC trial. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 72(7), 917–924. https://doi.org/10.1002/ccd.21714
Disciplines
Medicine and Health Sciences
PubMedID
19016469
Department(s)
Department of Medicine
Document Type
Article