Clopidogrel in Heart Failure in Connection with MI
The genuine article discussion and commentary based on articles from jack hello i’m tony de mariya the editor of jack here with another issue of the genuine article and on this occasion i’m talking to dr. lars cobra and larges professor of cardiology at university hospital in copenhagen and lars is one of the authors of a study in jack that has been directed towards
Studying the effect of clopidogrel in post myocardial infarction patients who have not undergone pci and especially with an eye on heart failure laura’s tell us about your study what prompted you to do it thank you it’s a pleasure to be here and first of all what this is a serious the study we started by studying in a nation how many patients are actually treated
With collette clopidogrel and then we found out that patients are actually undertreated there is the steadying rise in the treatment of clopidogrel but we found out that especially one or patients like heart failure patients were not treated and i think this come from the previous studies where they showed that well these paces have not been studied in detail so we
Looked at him who received it and if they received it how is the outcome of patients will out for you okay so this was really a registry study a denmark is very well suited to perform these registry studies isn’t it you can keep track of your patients quite well exactly in a small country five and five half million but we know where everyone lives and how it goes so
We can combine registers and we have no patience loss to follow-up and so what you did is you took a group of post-mi patients who had not undergone percutaneous intervention and you compared the patients who were treated subsequently with plop it a girl with the patients who were not and then looked separately at the patients with heart failure in the was without
As i understand the study and what did you find exactly and what we found was that patients who had heart failure seem to benefit when they were treated with clopidogrel there was a twelve to fourteen percent risk reduction in all-cause mortality if they had heart failure in the non heart failure group there was a smaller beneficial if you have two to four percent
But this was not as sceney this was not significant as in the art failure patients so it looks like if people are afraid of treating heart failure patients will prepare go on top of aspirin there’s no reason to be that i know it’s a register study but these associations were quite striking so i think based on on cure and commit trials that that there’s a consensus
That clopidogrel probably is indicated in patients who had a myocardial infarction how does your study add to that you see the cure study did not actually include very many patients with heart failure and it found a risk reduction in a combined endpoint of death mi and stroke while in the comet trial there was a reduction in all-cause mortality within 28 days and
That actually included twenty-five percent of patients with heart failure so it’s really telling us that this could be the explanation why it was that good in the comet trial and secondly when you have clinical trials you have problems with that patients are very selected and this we now take out to a whole nation where there’s no restriction will age gender what
Anything you actually could say because this is a prescription study we just look at who is going to take the prescription afterwards now do you think that there’s something unique about the pathophysiology of heart failure or was heart failure just a marker of the sicker patient who needed clopidogrel more that’s i think that’s a very interesting question because
It could be actually it could be both heart failure isn’t a a droid dramatic disease and they have a high likelihood of having erotic events so that could be a special beneficially faking heart failure patient i think we need to study to to see that but secondly yes it is a real marker of high risk well there’s no question that your study has really reinforced the
Need to treat post on my patients with clopidogrel especially if they have heart failure whether or not they undergo pci thanks very much for being with us and for the genuine article i’m tony de maria the genuine article discussion and commentary based on articles from jack you
Transcribed from video
Inside JACC | Clopidogrel in Heart Failure in Connection with MI By American College of Cardiology Video Archive 2
