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Optimal Timing for the Initiation of Pre-Treatment With 300 mg Clopidogrel Before Percutaneous Coronary Intervention

Steven R. Steinhubl, MD^_*,_*, Peter B. Berger, MD, Danielle M. Brennan, MS, Eric J. Topol, MD for the CREDO Investigators

^_* Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, Kentucky
Duke Clinical Research Institute, Duke University, Durham, North Carolina
Cleveland Clinic Foundation
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio

View larger version (8K): [in a new window]   Figure 1 Relationship between the duration of study drug treatment before percutaneous coronary intervention and log odds of the primary combined end point of death, myocardial infarction (MI), and urgent target vessel revascularization (UTVR). Dotted line = placebo; Solid line = clopidogrel.

View larger version (10K): [in a new window]   Figure 2 Kaplan-Meier curves of the occurrence of the primary combined end point of death, myocardial infarction (MI), and urgent target vessel revascularization (UTVR) in patients randomized to placebo, patients randomized to receive a 300-mg loading dose of clopidogrel that was initiated 15 h before percutaneous coronary intervention, and patients randomized to receive a 300-mg loading dose of clopidogrel that was initiated 15 h before percutaneous coronary intervention. For pre-treatment 15 h versus placebo, p = 0.018; for pre-treatment 15 h versus <15 h, p = 0.033; and for placebo versus pre-treatment <15 h, p = 0.72.

View larger version (12K): [in a new window]   Figure 3 Plot of the odds ratios (OR) with 95% confidence intervals of the 28-day primary end point for clopidogrel versus placebo based on duration of pre-treatment and glycoprotein (GP) IIb/IIIa antagonist use.