Clopidogrel may improve outcomes after CABG in patients with MI
Unapproved prescription cough, cold, allergy meds pulled
Clopidogrel may improve outcomes after coronary artery bypass grafting (CABG) for myocardial infarction (MI), a new study reports.
To evaluate the effect of clopidogrel on death and recurrent MI after CABG, Danish researchers examined data on patients admitted to the hospital with a first MI between 2002 and 2006 who underwent CABG within 180 days. They determined which patients received clopidogrel after discharge by looking at filled prescriptions. The main outcome measures were risk for death, recurrent MI or both. The study results appear in the March 8 Journal of the American College of Cardiology.
Study patients were followed for a mean of 466 ± 144 days. A total of 3,545 patients were included, 957 (27.0%) of whom received clopidogrel after CABG. Thirty-nine (4.1%) of those who received clopidogrel died or had a recurrent MI compared with 203 (7.8%) of those who did not receive clopidogrel (log-rank P=0.0003; hazard ratio, 0.59; 95% CI, 0.42 to 0.85). In a subgroup analysis of 945 patients matched by propensity score, 38 (4.0%) of those treated with clopidogrel died or had recurrent MI compared with 57 (6.0%) of those not treated with clopidogrel (log-rank P=0.05; hazard ratio, 0.67; 95% CI, 0.44 to 1.00). Rates of bleeding events after hospital discharge did not differ between groups.
The study was limited by its observational design, which did not allow the authors to definitively establish a causal relationship between clopidogrel and the primary outcomes. The authors also could not rule out selection bias. However, they concluded that clopidogrel treatment helped improve outcomes in patients with MI after CABG, but that the percentage of eligible patients who received clopidogrel treatment was low. They recommended that a randomized, controlled trial should be done to clarify the relationship between postoperative clopidogrel treatment and outcomes, and that more attention should be paid to prescribing clopidogrel at discharge in this group of patients.