Timing of clopidogrel loading before percutaneous coronary intervention in clopidogrel-naive patients with stable or unstable angina: A comparison of two strategies - 12/08/11
, Aggelos Arseniou, MD a, George Hahalis, MD a, John Chiladakis, MD a, Andreas Mazarakis, MD a, Anastasia Damelou, MD a, Marina Karakantza, MD b, Fotini Paliogianni, MD c, Nikolaos Karogiannis, MD a, Dimitrios Alexopoulos, MD, PhD, FACC aRésumé |
Background |
Clopidogrel-naive patients subjected to coronary angiography may be candidates for percutaneous coronary intervention (PCI). Clopidogrel loading with 600 mg at least 2 hours before the procedure is advised for such patients. However, there is no direct evidence that delaying PCI for 2 hours after clopidogrel loading is superior to ad hoc PCI.
Methods |
After coronary angiography, clopidogrel-naive patients (N = 199) with stable or unstable angina, candidates for PCI, were loaded with 900 mg of clopidogrel and then randomized to ad hoc PCI (ad hoc group, n = 103) or delayed PCI 2 hours after loading (delayed group, n = 96). Combined primary end point was death/periprocedural myocardial infarction (MI)/stroke/reintervention within 30 days post-PCI. Secondary end points were periprocedural MI; periprocedural creatine kinase-MB elevation >3 × upper limit of normal; any periprocedural increase of creatine kinase-MB, troponin-I, or myoglobin above upper limit of normal; Thrombolysis in Myocardial Infarction flow <3 after PCI; thrombocytopenia with platelet count of <70,000/mL; major bleeding defined according to the Thrombolysis in Myocardial Infarction criteria; and elevation of high-sensitivity C-reactive protein and soluble P selectin.
Results |
Primary end point occurred in 12.6% ad hoc group versus 15.6% delayed group patients (P = .34). High-sensitivity C-reactive protein increased in both groups post-PCI (analysis of variance P < .0001) without difference between groups (P = .5). Major bleeding occurred in 2.9% ad hoc group versus 3.1% delayed group patients (P = .9). No significant difference was observed in any other secondary end point.
Conclusions |
In clopidogrel-naive patients, a strategy of delaying PCI for 2 hours after high-dose clopidogrel loading does not seem to confer any benefit compared to ad hoc PCI.
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Vol 158 - N° 4
P. 585-591 - octobre 2009 Retour au numéro
Article précédent
- Drug-eluting stents: A study of international practice
- David Austin, Keith G. Oldroyd, David R. Holmes, Charanjit S. Rihal, P. Diane Galbraith, William A. Ghali, Victor Legrand, Yves Taeymans, Alex McConnachie, Jill P. Pell, on behalf of the APPROACH Investigators, Belgian Working Group on Invasive Cardiology, Mayo Clinic PCI Registry, and Scottish Coronary Revascularisation Registry
- Patterns of use of thienopyridine therapy after percutaneous coronary interventions with drug-eluting stents and bare-metal stents
- Dennis T. Ko, Maria Chiu, Helen Guo, Peter C. Austin, Jean-François Marquis, Jack V. Tu
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