Long-term clopidogrel therapy after percutaneous coronary intervention in PCI-CURE and CREDO: the “Emperor's New Clothes” revisited

The Clopidogrel in Unstable angina to prevent Recurrent Events (PCI-CURE) trial¹ showed that pretreatment with clopidogrel (300 mg loading dose, followed by 75 mg daily) in addition to aspirin for a median of 10 days before percutaneous coronary intervention (PCI), compared with aspirin alone, reduced the composite of cardiovascular death, myocardial infarction or urgent target vessel revascularisation by 30% (absolute risk reduction 1.9%, \(p=0.03\) ) after 1 month. Long-term clopidogrel therapy, after 1 month of open-label ticlopidine or clopidogrel in stented patients in both groups, reduced the composite of death, myocardial infarction or any revascularisation by 16% (absolute risk reduction 3.4%, \(p=0.03\) ) at the end of follow-up (mean 8 months). The authors concluded, “In patients with acute coronary syndrome receiving aspirin, a strategy of clopidogrel pretreatment (before PCI) followed by long-term therapy is beneficial in reducing major cardiovascular events, compared with placebo”.