Trial reportJournal of the American College of Cardiology2009
Interaction between cigarette smoking and clinical benefit of clopidogrel.
Trial report in Journal of the American College of Cardiology, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
34 citing papers in PubMed, 5 syntheses or guidelines pooled it, 124 citations in OpenAlex.
- The role ofExpert review of clinical pharmacology · 2022Pooled it
- Aspirin for primary prevention of cardiovascular disease: a meta-analysis with a particular focus on subgroups.BMC medicine · 2019 · on this mapPooled it
- Effectiveness and Safety of Platelet ADP -P2Y12 Receptor Inhibitors Influenced by Smoking Status: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2019Pooled it
- Effect of smoking on comparative efficacy of antiplatelet agents: systematic review, meta-analysis, and indirect comparison.BMJ (Clinical research ed.) · 2013Pooled it
- The "smoker's paradox" in patients with acute coronary syndrome: a systematic review.BMC medicine · 2011Pooled it
- Double-Dose Versus Standard-Dose Clopidogrel According to Smoking Status Among Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention.Journal of the American Heart Association · 2017Trial
- Effects of cigarette smoking on platelet reactivity during P2Y12 inhibition in patients with myocardial infarction undergoing drug-eluting stent implantation: results from the prospective cigarette smoking on platelet reactivity (COPTER) study.Journal of thrombosis and thrombolysis · 2016Trial
- Drug response testing for elective carotid artery stenting: Prevalence of non-response to aspirin and clopidogrel and influence on post-interventional occurrence of cerebral ischemia.The neuroradiology journal · 2026Article
- Predictors of Impaired Reperfusion in ST-Elevation Myocardial Infarction Treated with Primary PCI: Preliminary Results from COMA.NET Project.Diagnostics (Basel, Switzerland) · 2026Article
- Long-term all-cause mortality rate after ST-elevation myocardial infarction and its predictors: ST Elevation Myocardial Infarction Cohort in Isfahan Study.Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2025Article
- Unfolding the reality of the smoking paradox in a South Asian cohort of patients presenting with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention.SAGE open medicine · 2023Article
- Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry.Journal of clinical medicine · 2022Article
- Redox Mechanisms of Platelet Activation in Aging.Antioxidants (Basel, Switzerland) · 2022Review
- No Paradoxical Effect of Smoking Status on Recurrent Cardiovascular Events in Patients Following Percutaneous Coronary Intervention: Thai PCI Registry.Frontiers in cardiovascular medicine · 2022Article
- Safety of Oral P2Y12 Inhibitors in Interventional Neuroradiology: Current Status and Perspectives.AJNR. American journal of neuroradiology · 2021Review
- The Efficacy of P2Y12 Reactive Unit to Predict the Periprocedural Thromboembolic and Hemorrhagic Complications According to Clopidogrel Responsiveness and Safety of Modification of Dual Antiplatelet Therapy : A Meta-Analysis.Journal of Korean Neurosurgical Society · 2020Article
- Discharge Prescription Patterns for Antiplatelet Therapy Following Lower Extremity Peripheral Vascular Intervention.Circulation. Cardiovascular interventions · 2020Observational
- Risk Factors of New Cerebral Infarctions After Endovascular Treatment for Basilar Artery Stenosis Based on High-Resolution Magnetic Resonance Imaging.Frontiers in neurology · 2020Article
- The impact of smoking on mortality after acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a retrospective cohort outcome study at 3 years.Journal of thrombosis and thrombolysis · 2019Article
- Clopidogrel and ischemic stroke outcomes by smoking status: Smoker's paradox?Journal of the neurological sciences · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesThe aim of this study was to examine the interaction between cigarette smoking and the clinical efficacy of clopidogrel in ST-segment elevation myocardial infarction (STEMI).
backgroundCigarette smoking induces cytochrome P450 (CYP)1A2, which converts clopidogrel into its active metabolite, and prior studies suggest greater inhibition of platelet aggregation by clopidogrel in smokers of > or =10 cigarettes/day.
methodsThe effect of clopidogrel compared with placebo on angiographic and clinical outcomes was examined in 3,429 STEMI patients in the CLARITY-TIMI 28 (Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis In Myocardial Infarction 28) randomized trial stratified by smoking intensity as follows: not current smokers (n = 1,732), and smokers of 1 to 9 (n = 206), 10 to 19 (n = 354), 20 to 29 (n = 715), and > or =30 cigarettes/day (n = 422). Logistic regression was used to adjust for other baseline characteristics and interaction terms to test for effect modification.
resultsAlthough clopidogrel reduced the rate of the primary end point of a closed infarct-related artery or death/myocardial infarction before angiography in the CLARITY-TIMI 28 trial, the benefit was especially marked among those who smoked > or =10 cigarettes/day (adjusted odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.37 to 0.66; p < 0.0001) compared with those who did not (adjusted OR: 0.72, 95% CI: 0.57 to 0.91; p = 0.006; p(interaction) = 0.04). Similarly, clopidogrel was significantly more effective at reducing the rate of cardiovascular death, myocardial infarction, or urgent revascularization through 30 days among those who smoked > or =10 cigarettes/day (adjusted OR: 0.54, 95% CI: 0.38 to 0.76; p = 0.0004) compared with those who did not (adjusted OR: 0.98; 95% CI: 0.75 to 1.28; p = 0.87; p(interaction) = 0.006).
conclusionsCigarette smoking seems to positively modify the beneficial effect of clopidogrel on angiographic and clinical outcomes. This study demonstrates that common clinical factors that influence the metabolism of clopidogrel might impact its clinical effectiveness.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.