Comparison of Efficacy and Safety of a Standard Versus a Loading Dose of Clopidogrel for Acute Myocardial Infarction in Patients >75 Years of Age (from the FAST-MI Registry) Etienne Puymirat, MD a,b, *, Nadia Aïssaoui, MD a,b , Pierre Coste, MD c , Gilles Dentan, MD d , Vincent Bataille, MSc e , Elodie Drouet, MSc f , Geneviève Mulak, PharmD g , Dider Carrié, MD, PhD e , Didier Blanchard, MD a,b , Tabassome Simon, MD, PhD f,h , and Nicolas Danchin, MD, PhD a,b Data are lacking on the efficacy and safety of a loading dose (LD) of clopidogrel in elderly patients with acute myocardial infarction (AMI). FAST-MI is a nationwide registry that was carried out over a 1-month period in 2005 and included consecutive patients with AMI admitted to intensive care units <48 hours from symptom onset in 223 participating centers. We assessed the impact of a clopidogrel LD (>300 mg) compared to a conventional dose (<300 mg) on bleeding, need for blood transfusion, and 30-day and 12-month survivals in 791 elderly patients (>75 years old, mean age 81  4 years, 48% women, 35% with ST-segment elevation MI) included in this registry. Fifty-nine percent (466 patients) received a clopidogrel LD. Follow-up was >99% complete. Major bleeding and blood transfusions were not significantly different in patients who received a clopidogrel LD (3.2% vs 3.7%, p  0.72; 5.4% vs 6.2%, p  0.64, respectively). Early mortality was also not significantly different (10.1 vs 10.8, p  0.76). Using multivariate analyses, clopidogrel LD did not significantly affect major bleeding or transfusion (odds ratio 1.03, 95% confidence interval 0.49 to 2.17, p  0.94) and 12-month mortality (hazard ratio 1.00, 95% confidence interval 0.72 to 1.40, p  0.98). In conclusion, the present data showed that in elderly patients admitted for AMI, use of a LD of clopidogrel compared to a conventional dose was not associated with increased in-hospital bleeding, need for transfusion, or mortality. Large-scale randomized trials are still needed to identify the optimal LD of clopidogrel for elderly patients admitted for AMI. © 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;108:755–759) The objective of this study was to assess the impact of using a loading dose (LD) of clopidogrel (300 mg) com- pared to a conventional dose (300 mg) on major bleeding, need for transfusion, and 12-month survival in elderly pa- tients (75 years of age) with acute myocardial infarction (AMI) from the French Registry of Acute ST-Elevation or Non–ST-elevation Myocardial Infarction (FAST-MI) of the French Society of Cardiology. 1 Methods Patients 75 years of age receiving a known dose of clopidogrel 48 hours of admission and participating in the FAST-MI were included. Methods of the FAST-MI have been described in detail elsewhere. 1 Briefly, the primary objectives were to evaluate practices for MI management in “real-life” practice and to measure their impact on medium- and long-term prognoses of patients admitted to intensive care units (ICUs) for MI. This registry results from a pro- spective multicenter (223 centers) study including 3,059 patients. Patients were recruited consecutively from ICU departments over a period of 1 month (October 2005). Participation in the study was offered to all French institu- tions, university teaching hospitals, general and regional hospitals, and private clinics with ICUs authorized to re- ceive acute coronary syndrome (ACS) emergencies. In each center, a physician was in charge of the registry and pro- vided a full list of all patients admitted to the unit. Inclusion criteria were (1) men or women 18 years old; (2) patients admitted within 48 hours after symptom onset in an ICU for an AMI characterized by increased troponin or creatine kinase-MB associated with 1 of the following elements: symptoms compatible with myocardial ischemia, appearance of pathologic Q waves, or ST-T changes com- patible with myocardial ischemia (ST-segment elevation or depression, T-wave inversion); and (3) consent to take part a Division of Coronary Artery Disease and Intensive Cardiac Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pom- pidou, Paris, France; b Faculty of Medicine, University Paris Descartes, Paris, France; c Department of Cardiology, Hôpital Haut-Lévèque, Pessac, France; d Department of Cardiology, Clinique de Fontaine, Dijon, France; e Department of Cardiology B, Department of Epidemiology, Institut Na- tional de la Sante et de la recherche Medicale U558, Toulouse University Hospital, Toulouse, France; f Assistance Publique des Hôpitaux de Paris, URC-EST, St. Antoine Hospital, Paris, France; g Société Française de Cardiologie, Paris, France; h UPMC-Paris, 06 University, Paris, France. Manuscript received March 31, 2011; revised manuscript received and accepted April 29, 2011. FAST-MI is a registry of the French Society of Cardiology supported by unrestricted grants from Pfizer (New York, New York) and Servier (Neuilly, France). Additional support was obtained from a research grant from the Caisse Nationale d’Assurance maladie (Paris, France). *Corresponding author: Tel: 00-33-0-1-56-09-28-51; fax: 00-33-0-1- 56-09-25-71. E-mail address: etiennepuymirat@yahoo.fr (E. Puymirat). 0002-9149/11/$ – see front matter © 2011 Elsevier Inc. All rights reserved. www.ajconline.org doi:10.1016/j.amjcard.2011.04.028