Dramatic effect of early clopidogrel administration in reducing mortality and MACE rates in ACS patients. Data from the Swiss registry AMIS-Plus.
Détails
Etat: Public
Version: de l'auteur⸱e
ID Serval
serval:BIB_8B526C2489D3
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Dramatic effect of early clopidogrel administration in reducing mortality and MACE rates in ACS patients. Data from the Swiss registry AMIS-Plus.
Périodique
Swiss Medical Weekly
Collaborateur⸱rice⸱s
AMIS group
Contributeur⸱rice⸱s
Erne P., Bertel O., Eberli F., Essig M., Gutzwiller F., Hunziker P., Keller PF., Maggiorini M., Pedrazzini G., Radovanovic D., Rickli H., Stauffer JC., Urban P., Windecker S., Radovanovic D., Duvoisin N., Bähler C., Piket J., Doukas E., Hess F., Simon R., Hangartner P., Lessing P., Hufschmid U., Hunziker P., Grädel C., Schönfelder A., Windecker S., Schläpfer H., Evéquoz D., Vögele A., Ryser D., Jecker R., Niedermaier G., Droll A., Hongler T., Stäuble S., Haarer J., Schmid H., Quartenoud B., Bietenhard K., Gaspoz JM., Keller P., Wojtyna W., Oertli B., Schönenberger R., Waldburger R., Schmidli M., Weiss E., Zender H., Steffen C., Hugi A., Koltai E., Pedrazzini G., Erne P., Luterbacher T., Pagnamenta A., Urban P., Stettler C., Repond F., Widmer F., Lusser H., Polikar R., Bassetti S., Iselin H., Giger M., Egger P., Kaeslin T., Frey R., Herren T., Eichhorn P., Neumeier C., Flury G., Grêt A., Schöneneberger R., Rickli H., Yoon S., Loretan P., Stoller U., Veragut U., Bächli E., Weber A., Federspiel B., Weisskopf M., Schmidt D., Hellermann J., Graber M., Haller A., Peter M., Gasser S., Siegrist P., Fatio R., Vogt M., Ramsay D., Bertel O., Maggiorini M., Eberli F., Christen S.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Statut éditorial
Publié
Date de publication
2012
Volume
142
Pages
w13573
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Publication Status: epublish
Résumé
BACKGROUND: Patients who have acute coronary syndromes with or without ST-segment elevation have high rates of major vascular events. We evaluated the efficacy of early clopidogrel administration (300 mg) (<24 hours) when given with aspirin in such patients.
METHODS: We included 30,243 patients who had an acute coronary syndrome with or without ST segment elevation. Data on early clopidogrel administration were available for 24,463 (81%). Some 15,525 (51%) of the total cohort were administrated clopidogrel within 24h of admission.
RESULTS: In-hospital death occurred in 2.9% of the patients in the early clopidogrel group treated with primary PCI and in 11.4% of the patients in the other group without primary percutaneous coronary intervention (PCI) and no early clopidogrel. The unadjusted clopidogrel odds ratio (OR) for mortality was 0.31 (95% confidence interval 0.27-0.34; p <0.001). Incidence of major adverse cardiac death (MACE) was 4.1% in the early clopidogrel group treated with 1°PCI and 13.5% in the other group without primary PCI and no early clopidogrel (OR 0.35, confidence interval 0.32-0.39, p <0.001). Early clopidogrel administration and PCI were the only treatment lowering mortality as shown by mutlivariate analysis.
CONCLUSIONS: The early administration of the anti-platelet agent clopidogrel in patients with acute coronary syndromes with or without ST-segment elevation has a beneficial effect on mortality and major adverse cardiac events. The lower mortality rate and incidence of MACE emerged with a combination of primary PCI and early clopidogrel administration.
METHODS: We included 30,243 patients who had an acute coronary syndrome with or without ST segment elevation. Data on early clopidogrel administration were available for 24,463 (81%). Some 15,525 (51%) of the total cohort were administrated clopidogrel within 24h of admission.
RESULTS: In-hospital death occurred in 2.9% of the patients in the early clopidogrel group treated with primary PCI and in 11.4% of the patients in the other group without primary percutaneous coronary intervention (PCI) and no early clopidogrel. The unadjusted clopidogrel odds ratio (OR) for mortality was 0.31 (95% confidence interval 0.27-0.34; p <0.001). Incidence of major adverse cardiac death (MACE) was 4.1% in the early clopidogrel group treated with 1°PCI and 13.5% in the other group without primary PCI and no early clopidogrel (OR 0.35, confidence interval 0.32-0.39, p <0.001). Early clopidogrel administration and PCI were the only treatment lowering mortality as shown by mutlivariate analysis.
CONCLUSIONS: The early administration of the anti-platelet agent clopidogrel in patients with acute coronary syndromes with or without ST-segment elevation has a beneficial effect on mortality and major adverse cardiac events. The lower mortality rate and incidence of MACE emerged with a combination of primary PCI and early clopidogrel administration.
Mots-clé
Acute Coronary Syndrome/complications, Acute Coronary Syndrome/drug therapy, Adult, Aged, Aged, 80 and over, Aspirin/therapeutic use, Cardiac Catheterization, Confidence Intervals, Drug Therapy, Combination, Electrocardiography, Female, Hospital Mortality, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction/etiology, Odds Ratio, Platelet Aggregation Inhibitors/therapeutic use, Registries, Switzerland, Ticlopidine/analogs & derivatives, Ticlopidine/therapeutic use, Time Factors, Young Adult
Pubmed
Web of science
Open Access
Oui
Création de la notice
12/09/2012 17:58
Dernière modification de la notice
20/08/2019 15:49
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