Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Steinhubl and colleagues1 found that the benefits of clopidogrel were consistent
regardless of patients' characteristics. In this trial, many patients also
received glycoprotein IIb/IIIa inhibitors if the treating physician felt that
this additional therapy was indicated. One recent study, however, has found
that IIb/IIIa inhibition may have selective benefits for diabetic patients
with acute coronory symptoms, but not mortality advantage for nondiabetic
patients.2 Similarly, in the CURE trial,
patients with non-ST elevation who were at highest risk also had the greatest
absolute benefit of this treatment.2,3 Thus,
a subgroup analysis using the Thrombolysis in Myocardial Infarction (TIMI)
risk score would provide further information whether clopidogrel therapy might
be even more effective in high- and intermediate-risk patients.
Dirkali A, Umans VA. Clopidogrel and Percutaneous Coronary Interventions. JAMA. 2003;289(15):1925-1927. doi:10.1001/jama.289.15.1925-a