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The long-term use of both aspirin and clopidogrel for patients with an acute coronary syndrome was analyzed in the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study.1 In that trial, 12 562 patients with an acute coronary syndrome were randomly assigned to receive aspirin and clopidogrel or aspirin and placebo for a period of no more than 1 year. The results of the trial after a mean duration of follow-up of 9 months revealed an approximately 20% relative reduction in the risk of vascular death, myocardial infarction, and stroke. There were 2658 patients (21%) who underwent percutaneous coronary intervention (PCI) in the CURE trial a median of 10 days after enrollment. This was decided not by study protocol but by physician preference, which was influenced by the therapy to which patients were randomized; among these patients, the reduction in events (cardiovascular death, myocardial infarction [MI], or an urgent repeat revascularization procedure) from the PCI procedure through 30 days was an absolute1.9% (6.4% versus 4.5%), which was a relative reduction of 30% ( P =0.03).2 From the time of PCI through the remainder of follow-up, there was an absolute reduction in cardiovascular (CV) death and MI of 2% (8.0% versus 6.0%), which was a relative risk reduction of 25% ( P =0.047).Although dual antiplatelet therapy with clopidogrel and aspirin is often considered to be of benefit only in patients treated with stents, an interesting finding in PCI-CURE was that pretreatment and continued therapy with clopidogrel appeared to be as beneficial among the 19% of patients who did not receive a coronary stent as among the 81% of patients who did.2 There had not previously been evidence of benefit from thienopyridines use among patients undergoing PCI without stent placement, although it seems logical that there might be.3 …

Clinical Implications of Percutaneous Coronary Intervention-Clopidogrel in Unstable angina to prevent Recurrent Events (PCI-CURE) Study