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April 16, 2003

Clopidogrel and Percutaneous Coronary Interventions

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(15):1925-1927. doi:10.1001/jama.289.15.1925-a

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.