Comparison between ticlopidine and clopidogrel in patients undergoing primary stenting in acute myocardial infarction: Results from the CADILLAC trial†
Corresponding Author
Alexandra J. Lansky MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Department of Cardiology, Columbia University Medical Center, New York, New York
Columbia University Medical Center, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, NY 10022Search for more papers by this authorYoshihiro Tsuchiya MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Search for more papers by this authorMicheal Brener BSc
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Search for more papers by this authorRoxana Mehran MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Department of Cardiology, Columbia University Medical Center, New York, New York
Search for more papers by this authorEcaterina Cristea MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Search for more papers by this authorCody Pietras BA
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Search for more papers by this authorCindy L. Grines MD
Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
Search for more papers by this authorDavid A. Cox MD
Department of Cardiology, Mid Carolina Cardiology, Charlotte, North Carolina
Search for more papers by this authorEulogio Garcia MD
Department of Cardiology, Hospital Gregorio Maranon, Madrid, Spain
Search for more papers by this authorJames E. Tcheng MD
Department of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
Search for more papers by this authorGiulio Guagliumi MD
Department of Cardiology, Ospedali Riuniti di Bergamo, Bergamo, Italy
Search for more papers by this authorThomas Stuckey MD
Department of Cardiology, Moses Cone Memorial Hospital, Greensboro, North Carolina
Search for more papers by this authorMark Turco MD
Department of Cardiology, Doylestown Hospital, Doylestown, Pennsylvania
Search for more papers by this authorJohn D. Carroll MD
Department of Cardiology, University of Colorado Health Sciences Center, Denver, Colorado
Search for more papers by this authorBarry D. Rutherford MD
Department of Cardiology, St. Luke's Hospital, Kansas City, Missouri
Search for more papers by this authorMartin B. Leon MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Department of Cardiology, Columbia University Medical Center, New York, New York
Search for more papers by this authorJeffrey Moses MD
Department of Cardiology, Columbia University Medical Center, New York, New York
Search for more papers by this authorGregg W. Stone MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Department of Cardiology, Columbia University Medical Center, New York, New York
Search for more papers by this authorCorresponding Author
Alexandra J. Lansky MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Department of Cardiology, Columbia University Medical Center, New York, New York
Columbia University Medical Center, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, NY 10022Search for more papers by this authorYoshihiro Tsuchiya MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Search for more papers by this authorMicheal Brener BSc
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Search for more papers by this authorRoxana Mehran MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Department of Cardiology, Columbia University Medical Center, New York, New York
Search for more papers by this authorEcaterina Cristea MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Search for more papers by this authorCody Pietras BA
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Search for more papers by this authorCindy L. Grines MD
Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
Search for more papers by this authorDavid A. Cox MD
Department of Cardiology, Mid Carolina Cardiology, Charlotte, North Carolina
Search for more papers by this authorEulogio Garcia MD
Department of Cardiology, Hospital Gregorio Maranon, Madrid, Spain
Search for more papers by this authorJames E. Tcheng MD
Department of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
Search for more papers by this authorGiulio Guagliumi MD
Department of Cardiology, Ospedali Riuniti di Bergamo, Bergamo, Italy
Search for more papers by this authorThomas Stuckey MD
Department of Cardiology, Moses Cone Memorial Hospital, Greensboro, North Carolina
Search for more papers by this authorMark Turco MD
Department of Cardiology, Doylestown Hospital, Doylestown, Pennsylvania
Search for more papers by this authorJohn D. Carroll MD
Department of Cardiology, University of Colorado Health Sciences Center, Denver, Colorado
Search for more papers by this authorBarry D. Rutherford MD
Department of Cardiology, St. Luke's Hospital, Kansas City, Missouri
Search for more papers by this authorMartin B. Leon MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Department of Cardiology, Columbia University Medical Center, New York, New York
Search for more papers by this authorJeffrey Moses MD
Department of Cardiology, Columbia University Medical Center, New York, New York
Search for more papers by this authorGregg W. Stone MD
Department of Cardiology, Cardiovascular Research Foundation, New York, New York
Department of Cardiology, Columbia University Medical Center, New York, New York
Search for more papers by this authorConflict of interest: Nothing to report.
Abstract
Objective:
The aim of this article is to examine whether clopidogrel and ticlopidine treatments produce similar clinical outcomes for patients receiving primary stenting for acute myocardial infarction (AMI).
Background:
Prior studies have yielded conflicting results on the relative safety and efficacy of clopidogrel and ticlopidine after stent implantation, warranting an evaluation in primary stenting for AMI.
Methods:
In the multicenter, prospective CADILLAC trial, patients undergoing primary infarct stenting were treated at operator discretion with either ticlopidine (931 patients) or clopidogrel (163 patients) and then followed for 1 year. Baseline clinical and angiographic characteristics were comparable except for baseline TIMI 0/1 flow (72.5% clopidogrel vs. 63.9% ticlopidine, P = 0.04).
Results:
Patients receiving clopidogrel had more recurrent ischemia in hospital (6.1 vs. 2.8%, P = 0.02) and at 30 days (10.5 vs. 5.8%, P = 0.02), more moderate and severe bleeding at 30 days (7.4 vs. 2.7%, P = 0.002), and similar rates of stent thrombosis out to 1 year (P = 0.11). By multivariable analysis, clopidogrel use was an independent predictor for recurrent ischemia in hospital (P = 0.0002), and at 30 days (P = 0.012); and of moderate and severe bleeding in hospital (P = 0.002), and at 30 days (P = 0.001).
Conclusions:
Despite thienopyridines similarities, their efficacy may be different within the first 30 days of primary stenting for AMI. A prospective, randomized trial is required to confirm these findings. © 2008 Wiley-Liss, Inc.
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