Lansky AJ， Tsuchiya Y， Brener M， Mehran R， Cristea E， Pietras C， Grines CL， Cox DA， Garcia E， Tcheng JE， Guagliumi G， Stuckey T， Turco M， Carroll JD， Rutherford BD， Leon MB， Moses J， Stone GW.
Columbia University Medical Center， Department of Cardiology， Cardiovascular Research Foundation， New York， New York 10022， USA.
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.