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Randomized Controlled Trial
. 2008 Jun;29(12):1495-503.
doi: 10.1093/eurheartj/ehn169. Epub 2008 Apr 25.

Clopidogrel pre-treatment in stable angina: for all patients > 6 h before elective coronary angiography or only for angiographically selected patients a few minutes before PCI? A randomized multicentre trial PRAGUE-8

Petr Widimsky  1 , Zuzana Motovská, Stanislav Simek, Petr Kala, Radek Pudil, Frantisek Holm, Robert Petr, Dana Bílková, Hana Skalická, Petr Kuchynka, Martin Poloczek, Roman Miklík, Marek Maly, Michael Aschermann; PRAGUE-8 Trial Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Clopidogrel pre-treatment in stable angina: for all patients > 6 h before elective coronary angiography or only for angiographically selected patients a few minutes before PCI? A randomized multicentre trial PRAGUE-8

Petr Widimsky et al. Eur Heart J. 2008 Jun.

Abstract

Aims: To compare two different clopidogrel regimens on the outcomes of patients undergoing elective coronary angiography (CAG)+/-ad hoc percutaneous coronary intervention (PCI).

Methods and results: Open-trial randomized 1028 patients with stable angina to group A ('non-selective'-clopidogrel 600 mg > 6 h before CAG; n = 513) or group B ('selective'-clopidogrel 600 mg in the cath-lab after CAG, only in case of PCI; n = 515). Combined primary endpoint was death/periprocedural myocardial infarction (MI)/stroke/re-intervention within 7 days. Secondary endpoints were troponin elevation and bleeding complications. Primary endpoint occurred in 0.8% group A patients vs. 1% group B (P = 0.749; 90% CI for the percentage difference -1.2-0.8). Periprocedural troponin elevation (> 3 x ULN) was detected in 2.6% group A vs. 3.3% group B (P = 0.475; 90% CI -2.5-1.0). Bleeding complications occurred in 3.5% group A patients vs. 1.4% group B (P = 0.025). After adjustment for covariates and factors that may influence the bleeding risk, patients in group A were shown to have more likely bleeding complications when compared with group B (OR = 3.03; 95% CI 1.14-8.10; P = 0.027).

Conclusion: High (600 mg) loading dose of clopidogrel before elective CAG increased the risk of minor bleeding complications, while the benefit on periprocedural infarction was not significant. Clopidogrel can be given safely in the catheterization laboratory between CAG and PCI in chronic stable angina patients.

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Figures

Figure 1
Figure 1
Study patients and the treatment used.
Figure 2
Figure 2
Periprocedural troponin elevation (>3× ULN, per cent of patients).
Figure 3
Figure 3
Bleeding complications (major+minor, in per cent) among all study patients and among PCI patients only.
See this image and copyright information in PMC

Comment in

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