VIEWPOINT
Is CURE a cure for acute coronary syndromes? Statistical versus clinical significance
Umesh N. Khot, MD*,* and
Steven E. Nissen, MD, FACC*
* Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Manuscript received February 4, 2002;
revised manuscript received April 6, 2002,
accepted April 17, 2002.
* Reprint requests and correspondence: Dr. Umesh N. Khot, Department of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland Hts, Ohio 44195, USA. unkhot{at}bigfoot.com
Clopidogrel has been recently approved for treatment of nonST-elevation acute coronary syndromes based on the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial. However, the trials findings are confounded by issues that lessen its clinical significance. Clopidogrel did not reduce mortality; its benefit was limited to preventing myocardial infarction, which was defined less stringently than in previous trials. Clopidogrel led to an increase in major and minor bleeding. Furthermore, clopidogrel increased bleeding risk in early cardiac surgery. Thus, widespread usage of clopidogrel, especially in centers with an early revascularization strategy, will have limited clinical benefit with considerable risk.
|
Abbreviations and Acronyms
| | ACC | | American College of Cardiology | | ACS | | acute coronary syndrome | | CABG | | coronary artery bypass grafting | | CURE | | Clopidogrel in Unstable Angina to Prevent Recurrent Events trial | | MI | | myocardial infarction |
|
This article has been cited by other articles:

|
 |

|
 |
 
L. Goldman and J.-M. Gaspoz
Cost-Effectiveness of Clopidogrel: Seeing through the Smoke
Med Decis Making,
November 1, 2008;
28(6):
803 - 809.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
M. R Mehra, P. A Uber, and H. O Ventura
Death messengers
BMJ,
December 22, 2007;
335(7633):
1296 - 1297.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S J Walsh, M S Spence, D Crossman, and A A J Adgey
Clopidogrel in non-ST segment elevation acute coronary syndromes: an overview of the submission by the British Cardiac Society and the Royal College of Physicians of London to the National Institute for Clinical Excellence, and beyond
Heart,
September 1, 2005;
91(9):
1135 - 1140.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Garcia, M. J. Canoniero, J. A. Chirinos, E. de Marchena, T. Salerno, and A. Ferreira
Development of a Score to Predict the Need for Coronary Artery Bypass Graft Surgery in Patients With Non-ST Segment Elevation Acute Coronary Syndromes
Ann. Thorac. Surg.,
December 1, 2004;
78(6):
2022 - 2026.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. Chen, A. W. Bracey, R. Radovancevic, J. R. Cooper Jr, C. D. Collard, W. K. Vaughn, and N. A. Nussmeier
Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting
J. Thorac. Cardiovasc. Surg.,
September 1, 2004;
128(3):
425 - 431.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Eriksson
Long-term clopidogrel therapy in the drug eluting stent era: beyond CREDO and CURE-PCI: Reply
Eur. Heart J.,
August 1, 2004;
25(15):
1364 - 1365.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. Braunwald
Application of Current Guidelines to the Management of Unstable Angina and Non-ST-Elevation Myocardial Infarction
Circulation,
October 21, 2003;
108(90161):
III-28 - 37.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. D. Joyner and M. Flather
Statistical versus clinical significance of the cure study in acute coronary syndromes
J. Am. Coll. Cardiol.,
April 2, 2003;
41(7):
1233 - 1234.
[Full Text]
[PDF]
|
 |
|
|