004 Compared efficacy and safety of a standard versus a loading dose of clopidogrel at the acute stage of myocardial infarction in elderly patients. The FAST-MI registry data

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• 作者：Etienne Puymirat¹ ; Nadia Aissaoui¹ ; Pierre Coste² ; Gilles Dentan³ ; Fré ; dé ; ric Marco⁴ ; Michel Martelet⁵ ; Vincent Bataille⁶ ; Simon Tabassome⁷ ; Jean Ferrieres⁶ ; Nicolas Danchin¹
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2011
• 出版时间：January 2011
• 年：2011
• 卷：3
• 期：1
• 页码：2
• 全文大小：82 K

文摘

Background

Data are lacking on the efficacy and safety of a loading dose of clopidogrel in the elderly with acute myocardial infraction (AMI).

Aim

To determine 30-day and one-year mortality, as well as in-hospital bleeding risk in elderly patients with AMI according to the use of a loading dose of clopidogrel (?00 mg).

Methods

FAST-MI is a nationwide registry carried out over a 1-month period in 2005, including consecutive patients with AMI admitted to ICUs < 48 hours from symptom onset in 223 participating centers. We assessed impact of clopidogrel loading dose on bleeding, the need for blood transfusion and 12-month survival in elderly patients (aged ?5 years).

Results

791 elderly patients were included (Mean age 81 ¡À 4 years, 48 % women; 35 % STEMI). 59 % (466 patients) have received a clopidogrel loading dose (?00 mg). Follow up was > 98 % complete. Major bleeding and blood transfusions were not significantly different in patients having received a loading dose of clopidogrel or a conventional 75 mg dose, respectively 3.7 vs. 3.2 (p>0,05) and 6.2 vs. 5.4 (p>0,05). Early and one-year mortality were also not significantly different. Using multivariate analyses: Clopidogrel loading dose was not associated with a significant increase major bleeding or transfusion (OR = 1.09; 95 % CI: 0.50?.40, p = 0.82); and 12-month mortality (OR = 0.95; 95 % CI: 0.65?.29, p = 0.61).

Conclusion

The present data show that in elderly patients admitted for AMI, use of a loading dose of clopidogrel was not associated with increased in-hospital bleeding, need for transfusion, or mortality. These results persisted after mutivariate adjustment. Large-scale randomized trials are still needed to identify the optimal loading dose of clopidogrel for elderly patients admitted for AMI.