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Clopidogrel, an antiplatelet agent, is used widely in patients with acute coronary syndromes (ACS) and in those who undergo percutaneous coronary interventions, but it has substantial interpatient variability. Two new studies shed additional light on this topic.
In a substudy of 3429 people with ST-segment-elevation myocardial infarction (STEMI) who were enrolled in an industry-funded trial of clopidogrel, investigators stratified the cohort by smoking status (smoking induces the cytochrome P450 [CYP450] pathway that converts clopidogrel into its active metabolite). With clopidogrel, angiographic patency of infarct-related arteries at 2 to 8 days was significantly higher in smokers than in nonsmokers (adjusted odds ratio for a closed infarct…