Among patients scheduled for percutaneous coronary intervention (PCI), clopidogrel pretreatment was associated with a lower risk of major coronary events, according to a review published in the Journal of the American Medical Association. However, it was not associated with a lower risk of mortality.

The review, which was based on a review of six randomized controlled trials (RCTs), two observational analyses of RCTs and seven observational studies published between Aug. 2001 and Sept. 2012, found that clopidogrel pretreatment was associated with a lower risk of major cardiac events (9.83 percent vs. 12.35 percent; OR, 0.77; 95 percent CI, 0.66-0.89; P.001) but was not associated with a reduction of death (absolute risk, 1.54 percent vs. 1.97 percent; OR, 0.80; 95 percent CI, 0.57-1.11; P= .17) There was no significant association between pretreatment and major bleeding overall (3.57 percent vs. 3.08 percent; OR, 1.18; 95 percent CI, 0.93-1.50; P=.18).

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The study authors noted that while no significant heterogeneity existed for clinical presentation, the higher-risk ST-elevation myocardial infarction population appeared to gain the most benefit from pretreatment. In contrast, however, they said "patients undergoing elective PCI had no apparent benefit from clopidogrel pretreatment, questioning the need of such a systematic strategy at least in low-risk patients." Moving forward, the authors recommend larger prospective studies that assess the value of pretreatment, including the use of new antiplatelet agents.

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