Document Detail


Association between smoking, outcomes, and early clopidogrel use in patients with acute coronary syndrome: insights from the Global Registry of Acute Coronary Events.
MedLine Citation:
PMID:  21095272     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Smoking induces CYP1A2, thereby enhancing clopidogrel conversion to its active metabolite. We sought to determine the association between clopidogrel use and clinical outcomes in smokers versus nonsmokers with a broad spectrum of acute coronary syndrome (ACS).
METHODS: We examined the association between early clopidogrel use in-hospital and 6-month outcomes among 44,426 patients with ACS in relation to smoking status in the Global Registry of Acute Coronary Events. We tested for heterogeneity of clopidogrel effect among smokers versus nonsmokers in separate multivariable models that adjusted for (1) established prognosticators in the Global Registry of Acute Coronary Events risk score and (2) independent predictors of major bleeding.
RESULTS: Rates of in-hospital mortality, death/myocardial infarction, and major bleeding were 4.3%, 5.9%, and 2.5%, respectively. Current smokers (n = 12,149) were more likely to be younger men without documented vascular disease; had lower rates of hypertension, hyperlipidemia, and diabetes; and more frequently presented with ST elevation (all P < .0001). Early clopidogrel use (55%) was associated with a reduction in the composite endpoint of mortality and myocardial infarction both in-hospital and at 6 months among current smokers and nonsmokers. There was no interaction between current smoking and clopidogrel use for ischemic endpoints. Major bleeding associated with early clopidogrel use was actually lower among current smokers compared with nonsmokers.
CONCLUSIONS: Despite prior observations of smoking-enhanced clopidogrel effects, early clopidogrel use among smokers presenting with ACS compared with nonsmokers was not independently associated with a greater reduction in cardiovascular events. In contrast with nonsmokers, clopidogrel use among smokers was not associated with excess bleeding, perhaps because of unmeasured confounders.
Authors:
Matthew Sibbald; Andrew T Yan; Wei Huang; Keith A A Fox; Joel M Gore; Ph Gabriel Steg; Kim A Eagle; David Brieger; Gilles Montalescot; Shaun G Goodman
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  855-61     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Mosby, Inc. All rights reserved.
Affiliation:
Division of Cardiology, Canadian Heart Research Center and Terrence Donnelly Heart Center, St Michael's Hospital, University of Toronto, Toronto, Ontario.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis,  drug therapy,  epidemiology*
Aged
Aged, 80 and over
Coronary Angiography
Electrocardiography / drug effects
Female
Follow-Up Studies
Hemorrhage / chemically induced,  epidemiology
Hospital Mortality / trends
Humans
Incidence
Male
Middle Aged
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Prognosis
Registries / statistics & numerical data*
Risk Factors
Smoking / adverse effects*,  epidemiology
Survival Rate / trends
Ticlopidine / adverse effects,  analogs & derivatives*,  therapeutic use
Time Factors
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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