A randomized trial comparing clopidogrel versus ticlopidine therapy in patients undergoing infarct artery stenting for acute myocardial infarction with abciximab as adjunctive therapy - 21/08/11
, Roberto Sciagrà, MD b, Angela Migliorini, MD a, Gentian Memisha, MD a, Guia Moschi, MD a, Renato Valenti, MD a, Alberto Pupi, MD b, David Antoniucci, MD aRésumé |
Aim |
To evaluate the impact of a clopidogrel therapy on the effectiveness of myocardial reperfusion in patients with ST-segment elevation acute myocardial infarction (AMI) undergoing routine infarct-related artery (IRA) stent implantation and receiving routine abciximab therapy.
Background |
Inflammatory processes after mechanical restoration of flow in AMI play a central role in decreasing the effectiveness of reperfusion at microcirculatory level. Several studies suggest that clopidogrel may exert a protective effect against adverse cardiovascular events by virtue of its anti-inflammatory properties.
Methods |
A total of 133 patients with a first ST-elevation AMI were randomized to clopidogrel (600-mg loading dose before IRA stenting followed by 75 mg daily, n = 66) or ticlopidine (500 mg before IRA stenting followed by 250 mg twice daily, n = 67). The primary end point was scintigraphic infarct size at 1 month. The secondary end points were ST-segment elevation resolution within 3 hours of procedure and 1-month clinical outcome, as a composite of death, reinfarction, target vessel revascularization, and stroke within 1 month of the index procedure.
Results |
The 1-month technetium 99m sestamibi scintigraphy revealed similar infarct size (16.2% ± 14.6% vs 15.0% ± 14.1%, P = .703) and severity (0.48 ± 0.18 vs 0.49 ± 0.15, P = .592) in the clopidogrel group as compared with the ticlopidine group. Three-hour ST-segment resolution rate was similar in the 2 study groups (86% vs 89%, P = .642). At 1 month, there was no difference in major cardiovascular adverse event rate (3% vs 3%, P = .988). Discontinuation of thienopiridine therapy within the first month occurred in no patient randomized to clopidogrel and in 3 (4.5%) patients randomized to ticlopidine (P = .082).
Conclusion |
Clopidogrel has no impact on the effectiveness of myocardial reperfusion in patients with AMI treated routinely with stenting and abciximab. However, clopidogrel, administered as a 600-mg loading dose followed by 75 mg daily, is safe and at least as effective as the standard ticlopidine therapy in this subgroup of patients.
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| This study was supported by a research grant from the ARCARD ONLUS Foundation, Florence, Italy. |
Vol 150 - N° 2
P. 220.e1-220.e5 - août 2005 Retour au numéro
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