Timeliness of Clopidogrel Administration for Acute Myocardial Infarction in the Emergency Department: Is Door-to-drug Time a Good Indicator of Outcome?
Date Issued
2009
Date
2009
Author(s)
Chi, Chun-Lin
Abstract
Background: Although clopidogrel treatment has become a standard therapy in the management of acute myocardial infarction, the optimal timing for initial clopidogrel administration is yet to be determined.bjective: To explore the association of time of initial clopidogrel administration in the emergency department (ED) and patient outcomes.ethods: This retrospective, observational study was conducted at two university tertiary hospitals and one community hospital. Consecutive patients with acute myocardial infarction (n=254) were enrolled from September 2004 to August 2006. Patients with contraindications for clopidogrel treatment were excluded. Patient characteristics, initial treatment time, and adverse outcomes were recorded. Subjects were classified as early group (treatment initiated within 4 hours of ED arrival) and late group (treatment initiated later than 4 hours).esults: The early group demonstrated a much lower rate of adverse outcomes (2.8% vs. 12.6% in late group, P=0.003). The benefits of early administration of clopidogrel persisted after stratification and adjustment for patient and clinical factors. Late clopidogrel administration was associated with significantly increased adverse outcomes (adjusted odds ratio, 5.105, 95% confidence interval, 1.596 to 16.333, P=0.006). When the late group was further divided into two subgroups (4-24 hrs vs. > 24 hrs), a graded association was noted between time to initial clopidogrel administration and adverse outcomes (Chi-square for trend, P=0.002). Patients receiving clopidogrel >24 hours of ED presentation had the highest incidence of adverse outcomes.onclusions: Patients who receive early clopidogrel treatment in the ED have significantly reduced adverse outcomes after acute myocardial infarction.ey words: clopidogrel, myocardial infarction, timing of administration
Subjects
myocardial infarction
timing of administration
Type
thesis
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