Clopidogrel pretreatment in PCI: Absolute requirement or obsolete myth?

There are several unanswered questions regarding clopidogrel loading prior to PCI. What is the optimal loading dose and timing of administration? Is non selective loading of all candidates of coronary angiography/possible PCI beneficial? What is the effect of adjunctive GPIIb/IlIa antagonists or bivalirudin treatment? Is a different policy necessary in ACS compared to stable coronary artery disease PCI? How we should act to overcome the increasingly recognized clopidogrel resistance? Recent experience suggests that there is no trend for less periprocedural events with delayed PCI following high dose clopidogrel loading compared to immediate PCI after loading. Several uncertain aspects are discussed.