CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events)

18 Mar, 14

CURE

CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events)

Reduction in CV mortality and ischemic events in patients with acute coronary syndromes: Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial

Aim

To compare the efficacy and safety of the early and long-term use of clopidogrel plus aspirin with those of aspirin alone in patients with acute coronary syndromes (ACS)

Study Patients

ACS (N = 12,562)

Study Drugs

Clopidogrel (300 mg followed by 75 mg) + Aspirin (75-325 mg) vs Placebo + Aspirin

Study Duration

3-12 months (mean 9 months)

Results

Reductions in events were seen as early as within 24 hours.

Benefits observed as early as 30 days and sustained at the end of 1 year

The addition of clopidogrel reduced the risk of cardiovascular death, nonfatal myocardial infarction or stroke by 20%.
Risk of cardiovascular death, nonfatal myocardial infarction, stroke or refractory ischemia was reduced by 14%.
Risk of myocardial infarction was reduced by 23% while risk of stroke was reduced by 14%.
Risk of heart failure was reduced by 18%.
Need for revascularisation procedures was reduced by 8% and risk of refractory ischemia during initial hospitalisation was reduced by 32%.
Importantly, the need for thrombolytics and GP IIb/IIIa antagonists was also reduced.

Safety

Bleeding more common in clopidogrel + aspirin group compared to aspirin alone (3.7% vs 2.7%)
No increased risk of fatal bleeding or hemorrhagic stroke
Risk of neutropenia and thrombocytopenia similar
Discontinuation rates similar

Conclusion

Early addition of clopidogrel to existing aspirin therapy provides additional benefits as compared to aspirin alone in ACS patients. These benefits were maintained for long-term.

NEJM 2001; 345: 494-502