Key result
Upstream use of clotinab under 600-mg clopidogrel pretreatment did not significantly reduce 30-day major adverse cardiac and cerebrovascular events compared to provisional use in STEMI patients.
Why the study?
Does upstream use of clotinab reduce 30-day composite events compared to provisional use in STEMI patients pretreated with 600-mg clopidogrel?
RCT (n=786)
Single-blind
1:1 Web-based computer-generated sequence
Yes
Does upstream use of clotinab reduce 30-day composite events compared to provisional use in STEMI patients pretreated with 600-mg clopidogrel?
Answers are grounded in this paper and cite their sources.
Upstream administration of clotinab in STEMI patients pretreated with clopidogrel does not significantly reduce 30-day ischemic events but increases major bleeding compared to provisional use during PCI.
BACKGROUND: This study investigated the efficacy and the safety of the upstream glycoprotein (Gp) IIb/IIIa inhibitor (clotinab; ISU ABXIS, Seoul, Republic of Korea) under 600-mg clopidogrel pretreatment compared with provisional use in ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 786 STEMI patients were randomized to upstream use in the emergency room (ER) (n = 392) or provisional use during percutaneous coronary intervention (PCI) (n = 394). All patients were prescribed 600-mg clopidogrel in the ER. The primary endpoint was the 30-day incidence of composite events including death, nonfatal myocardial infarction, target vessel revascularization, and stroke. There was no significant difference in the events that occurred in 40 patients (10.2%) in the upstream arm and 55 patients (14.0%) in the provisional arm during the 30 days (odds ratio 0.70, 95% confidence interval 0.45-1.08). Major bleeding was higher in the upstream arm (1.5% vs. 0%, P = 0.02). However, there was a significant reduction in 30-day composite events in the upstream arm in the high-risk population (Killip class ≥II or GRACE score >140). CONCLUSIONS: The upstream use of clotinab under a 600-mg clopidogrel loading may not significantly reduce cardiac events following primary PCI but may improve the clinical outcome in high-risk patients.
No takes yet. Share an insight, caveat, or question.
Kim et al. (2011) conducted an RCT in ST-elevation myocardial infarction (STEMI) (n=786). Upstream clotinab vs. Provisional clotinab during PCI was evaluated on 30-day incidence of major adverse cardiac and cerebrovascular events (MACCE: death, nonfatal MI, TVR, stroke) (OR 0.70, 95% CI 0.45-1.08, p=0.14). Upstream use of clotinab under 600-mg clopidogrel pretreatment did not significantly reduce 30-day major adverse cardiac and cerebrovascular events compared to provisional use in STEMI patients.
Synapse has enriched 10 related papers. Consider them for comparative context: