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Clopidogrel and Percutaneous Coronary Interventions—Reply
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In Reply: Dr Choudhury suggests that selection bias may have contributed to the difference in outcomes with clopidogrel pretreatment of less vs greater than 6 hours. As we noted in our article, there was no difference in patient baseline characteristics based on time of pretreatment, and all subgroups of patients derived similar benefit, or lack of it, based on the timing of pretreatment. Nonetheless, it is possible that unmeasured variables differed between the 2 groups. Choudhury, as well as Dr Bridges and Dr Borja and colleagues highlight the methodological issues with evaluating multiple interventions in clinical trials and the lack of a factorial design in our study. We agree that rerandomization would have been ideal. However, a lack of any plausible mechanism for a single loading dose of clopidogrel being able to prevent stokes, spontaneous myocardial infarctions, and death 1 to 12 months following its administration helped us decide to . . . [Full Text of this Article]
Steven R. Steinhubl, MD
Division of Cardiology
University of North Carolina at Chapel Hill
Peter B. Berger, MD
Cardiovascular Diseases Division
Mayo Clinic
Rochester, Minn
J. Tift Mann III, MD
WakeMed
Raleigh, NC
Edward T. A. Fry, MD
Department of Cardiology
St Vincent Hospital
Indianapolis, Ind
Augustin DeLago, MD
Cardiology Division
Albany Medical Center
Albany, NY
Charles Wilmer, MD
Atlanta Medical Center
Atlanta, Ga
Eric J. Topol, MD
Department of Cardiovascular Medicine
Cleveland Clinic Foundation
Cleveland, Ohio
For the CREDO Investigators
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