Clopidogrel pretreatment effect according to the clinical presentation in patients undergoing percutaneous coronary intervention: a meta-analysis

Purpose: Although Clopidogrel pretreatment is recommended for Acute Coronary Syndrome (ACS) and stable coronary patients scheduled for Percutaneous Coronary Intervention (PCI), the benefit of this strategy compared to an administration at the time of PCI has not been shown on hard clinical outcome. In this new analysis, we performed a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) and registries to evaluate the impact of clopidogrel pretreatment on mortality, MACE and major bleeding after PCI, as compared with no pretreatment. Methods: We included studies from MEDLINE, EMBASE, Cochrane Controlled Trials Register databases and references lists of qualifying articles that reported clinical data on mortality and major bleeding. A random-effect model was applied. Pretreatment was defined as the administration of clopidogrel before PCI or catheterization. The primary efficacy and safety endpoints were all-cause mortality and major bleeding, respectively. Results: Of the 392 titles identified, 15 articles met the inclusion criteria, published between August 2001 and September 2012, including 37 914 patients: 13 628 patients with stable coronary artery disease (CAD), 15 650 with Non ST Elevation ACS (NSTE ACS) and 8 536 with ST elevation ACS (STEMI) presentation. Results for Death, Major Bleeding and MACE are shown in Figure I. ![Figure][1] Figure 1. Main ischemic and bleeding end point Conclusion: Among patients scheduled for PCI, clopidogrel pretreatment was not associated with a lower risk of mortality nor with an increase in major bleeding overall but with differential effect according clinical presentation. Only STEMI patients undergoing primary PCI appear to draw a benefit from pre treatment with clopidogrel. In other patients, treatment at the time of PCI appears to be sufficient. [1]: pending:yes