Comparison of 600 versus 300-mg Clopidogrel loading dose in patients with ST-segment elevation myocardial infarction undergoing primary coronary angioplasty.

Details

Serval ID
serval:BIB_A8A4494F5CA1
Type
Article: article from journal or magazin.
Collection
Publications
Title
Comparison of 600 versus 300-mg Clopidogrel loading dose in patients with ST-segment elevation myocardial infarction undergoing primary coronary angioplasty.
Journal
American Journal of Cardiology
Author(s)
Mangiacapra F., Muller O., Ntalianis A., Trana C., Heyndrickx G.R., Bartunek J., Vanderheyden M., Wijns W., De Bruyne B., Barbato E.
ISSN
1879-1913 (Electronic)
ISSN-L
0002-9149
Publication state
Published
Issued date
2010
Volume
106
Number
9
Pages
1208-1211
Language
english
Abstract
The aim of the present study was to compare 600- and 300-mg clopidogrel loading doses in patients with ST-segment elevation myocardial infarctions who underwent primary percutaneous coronary intervention (PCI). Two hundred fifty-five consecutive patients presenting with ST-segment elevation myocardial infarctions who underwent primary PCI were enrolled. Patients were divided into 2 groups on the basis of the loading dose of clopidogrel received before the procedure (600 vs 300 mg). Procedural angiographic end points and 1-year major adverse cardiac events were compared between the 2 groups. Major adverse cardiac events were defined as death, nonfatal myocardial infarction, and target vessel revascularization. There were no significant differences in baseline clinical and angiographic features between the 2 groups: 157 (62%) in the clopidogrel 600 mg group and 98 (38%) in the 300 mg group. Patients receiving 600-mg loading dose of clopidogrel showed a significantly lower incidence of post-PCI myocardial blush grade 0 or 1 (odds ratio 0.64, 95% confidence interval 0.43 to 0.96, p = 0.03) and significantly less common no-reflow phenomenon (odds ratio 0.38, 95% confidence interval 0.15 to 0.98, p = 0.04) compared to those in the 300-mg group. Propensity-adjusted Cox analysis showed significantly higher survival free of major adverse cardiac events in patients receiving 600-mg loading dose of clopidogrel compared to those receiving the lower dose (hazard ratio 0.57, 95% confidence interval 0.33 to 0.98, p = 0.04). In conclusion, a 600-mg loading dose of clopidogrel is associated with improvements in procedural angiographic end points and 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction who undergo primary PCI compared to a 300-mg dose.
Keywords
Aged, Angioplasty, Balloon, Coronary, Chi-Square Distribution, Combined Modality Therapy, Coronary Angiography, Female, Humans, Logistic Models, Male, Middle Aged, Myocardial Infarction/drug therapy, Myocardial Infarction/therapy, No-Reflow Phenomenon, Platelet Aggregation Inhibitors/administration & dosage, Proportional Hazards Models, Prospective Studies, Registries, Survival Rate, Ticlopidine/administration & dosage, Ticlopidine/analogs & derivatives, Treatment Outcome
Pubmed
Web of science
Create date
16/02/2015 17:58
Last modification date
20/08/2019 15:13
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