NEW YORK (Reuters Health) – Clopidogrel improves outcomes not only in patients with myocardial infarction undergoing primary percutaneous coronary intervention, but also in MI patients revascularized by coronary artery bypass graft (CABG) surgery, a Danish team has shown.
Their findings are reported in the March 8 issue of the Journal of the American College of Cardiology. “Even though guidelines since 2004 have recommended that clopidogrel should be continued for a period of 9 to 12 months for acute coronary syndrome patients revascularized by CABG,” the authors note, “concerns have been raised about the actual benefit of clopidogrel treatment for these patients.”
To investigate this issue, Dr. Rikke Sorensen, with Copenhagen University Hospital, Gentofte, and colleagues studied the effect of clopidogrel treatment on mortality and recurrent MI among all 3,545 first-time MI patients in Denmark who were revascularized by CABG within 180 days after admission.
Only 957 of these patients (27.0%) were treated with clopidogrel after CABG. The rate of the combined endpoint of death or recurrent MI in this group was 4.1% compared with 7.8% among those not treated with clopidogrel (hazard ratio, 0.59; p=0.0003), the investigators found.
Among a subset of patients matched by propensity score, corresponding endpoint rates were 4.0% vs. 6.0% (HR, 0.67; p=0.05), according to the report.
Summing up, Dr. Sorensen and colleagues write: “In a cohort of real-life, first-time MI patients revascularized with CABG, only 27% were treated with clopidogrel after surgery. Fewer of these patients died or experienced a combined end point of recurrent MI and death compared with patients without clopidogrel treatment.”
They add, “A focus on discharge clopidogrel treatment of these patients should be made.”
J Am Coll Cardiol 2011;57:1202–1209.