接受溶栓治疗的ST段抬高心肌梗死患者行经皮冠状动脉介入术前氯吡格雷预处理的作用:PCI-CLARITY研究

作     者：Sabatine M. S. Cannon C. P. Gibson C. M. 王亭忠 

作者机构：Sabatine Cardiovascular Division TIMI Study Group Brigham and Women' s Hospital 75 Francis St Boston MA 02115 United States Dr. 

出 版 物：《世界核心医学期刊文摘(心脏病学分册)》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2期

页      面：19-20页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：溶栓治疗 氯吡格雷 PCI-CLARITY 经皮冠状动脉介入术 ST 预处理 前处理 

摘      要：Context: The benefit of clopidogrel pretreatment before percutaneous coronary intervention(PCI) remains debated and its use has not been universally adopted. Objective: To determine if clopidogrel pretreatment before PCI in patients with recent ST-segment elevation myocardial infarction(STEMI) is superior to clopidogrel treatment initiated at the time of PCI in preventing major adverse cardiovascular events. Design, Setting, and Participants: The PCI-Clopidogrel as Adjunctive Reperfusion Therapy(CLARITY) study was a prospectively planned analysis of the 1863 patients undergoing PCI after mandated angiography in CLARITY-Thrombolysis in Myocardial Infarction(TIMI) 28, a randomized, double-blind, placebo-controlled trial of clopidogrel in patients receiving fibrinolytics for STEMI. Patients were enrolled at 319 sites in 23 countries from February 2003 through October 2004. Interventions: Patients received aspirin and were randomized to receive either clopidogrel(300 mg loading dose, then 75 mg once daily) or placebo initiated with fibrinolysis and given until coronary angiography, which was performed 2 to 8 days after initiation of the study drug. For patients undergoing coronary artery stenting, it was recommended that open-label clopidogrel(including a loading dose) be administered after the diagnostic angiogram. Main Outcome Measures: The primary outcome was the incidence of the composite of cardiovascular death, recurrent MI, or stroke from PCI to 30 days after randomization. Secondary outcomes included MI or stroke before PCI and the aforementioned composite from randomization to 30 days. Results: Pretreatment with clopidogrel significantly reduced the incidence of cardiovascular death, MI, or stroke following PCI(34 3.6% vs 58 6.2% ; adjusted odds ratio OR , 0.54 95% CI, 0.35-0.85 ; P=.008). Pretreatment with clopidogrel also reduced the incidence of MI or stroke prior to PCI(37 4.0% vs 58 6.2% ; OR, 0.62 95% CI, 0.40-0.95 ; P=.03). Overall, pretreatment with clo