Medication before angiograph significantly reduces risk of heart attack

Sep 4 2005

According to new research if patients are given the a drug which reduces platelet activity in the blood risk of heart attack and cardiovascular death before and after angioplasty is reduced.

The researchers at Brigham and Women's Hospital and Harvard Medical School found that the antiplatelet drug clopidogrel, if given before a coronary angioplasty, reduced the risk of cardiovascular death, heart attack or stroke within 30 days following the procedure.

Angioplasty is a treatment in which a catheter-guided balloon is used to open a narrowed coronary artery, and is often accompanied by placement of a stent in the artery, (PCI).

By using a combination of a drugs such as clopidogrel along with aspirin, the risk of further heart attacks is reduced, but the best time to begin using clopidogrel has always been unclear.

Also unclear was whether there was any benefit for the drug to be given hours or days before PCI compared with treatment given at the time of PCI in high-risk patients as current guidelines do not universally recommend treatment before surgery.

Marc S. Sabatine, M.D., M.P.H., and colleagues carried out a study to see if clopidogrel pretreatment hours to days before PCI was superior to clopidogrel treatment initiated at the time of PCI, in preventing major adverse cardiovascular events.

The study included an analysis of 1,863 patients undergoing PCI, enrolled at 319 sites, in 23 countries from February 2003 through October 2004.

The patients received aspirin and were randomized to receive either clopidogrel or a placebo until coronary angiography, which was performed 2 to 8 days after initiation of the study drug.

The researchers found that pretreatment with clopidogrel significantly reduced by 46 percent the odds of cardiovascular death, heart attack, or stroke following PCI.

and also reduced the odds by 38 percent of heart attack or stroke prior to PCI.

Overall, pretreatment with clopidogrel resulted in a 41 percent reduction in the odds of cardiovascular death, heart attack, or stroke, and there was no significant excess in the rates of major or minor bleeding.

The researchers say that in every 100 patients, 4 major cardiovascular events can be avoided simply by the use of 1 to 3 doses of clopidogrel before PCI.

They say the significant reduction in adverse cardiovascular events before PCI suggests that a strategy of clopidogrel pretreatment should be initiated as soon as possible, and even if clopidogrel is not given prior to the surgery, once the decision is made to carry out an angiograph and hence possible PCI, the drug will maximize the benefit.

The article appears in the September 14 issue of JAMA: The Journal of the American Medical Association.

http://jama.ama-assn.org/