CLARITY about the use of clopidogrel in patients with acute coronary syndromes and myocardial infarction

Clopidogrel was shown to have added benefits to aspirin in patients with acute coronary syndromes without ST-segment elevation in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial. The cost in CURE was estimated to be US$442 greater in the clopidogrel group and the incremental cost-effectiveness ratio (incremental cost/life-year gained) was US$6318. Clopidogrel has also recently been shown to have added benefits to aspirin in patients with myocardial infarction with ST-segment elevation in the Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY) - Thrombolysis in Myocardial Infarction (TIMI) 28 study. The primary efficacy composite end point in CLARITY was an occluded infarct-related artery, death from any cause prior to angiography, or recurrent myocardial infarction, and this end point occurred less in the clopidogrel group (15%, 262 of 1752 patients) than placebo group (21.7%, 377 of 1739 patients). This difference was predominantly due to a reduction in the occluded infarct-related artery, which occurred in less of the clopidogrel (11.7%) than placebo group (18.4%). There was also a reduction in urgent revascularisations in the clopidogrel group of CLARITY. Thus, clopidogrel is effective and cost effective in acute coronary syndromes, and is also beneficial in patients with myocardial infarction with ST-segment elevation.