Lack of efficacy of clopidogrel pre-treatment in the prevention of myocardial damage after elective stent implantation

The object of this study was to determine the effect of pre-treatment with clopidogrel in patients undergoing elective stent implantation. The treatment of patients with adenosine diphosphate receptor blockers after percutaneous coronary intervention (PCI) with stent implantation has been shown to d...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2004-07, Vol.44 (1), p.20-24
Main Authors: van der Heijden, Dirk J, Westendorp, Iris C.D, Riezebos, Robert K, Kiemeneij, Ferdinand, Slagboom, Ton, van der Wieken, L.Ron, Laarman, Gert-Jan
Format: Article
Language:English
Subjects:
Aged
Angioplasty
Angioplasty, Balloon, Coronary
Biomarkers - blood
Blood Vessel Prosthesis Implantation
Cardiology
Coronary Angiography
Coronary Disease - blood
Coronary Disease - diagnostic imaging
Coronary Disease - therapy
Coronary vessels
Creatine Kinase - blood
Creatine Kinase, MB Form
Drug therapy
Female
Follow-Up Studies
Heart attacks
Humans
Isoenzymes - blood
Male
Middle Aged
Myocardial Infarction - blood
Myocardial Infarction - etiology
Myocardial Infarction - prevention & control
Netherlands
Platelet Aggregation Inhibitors - therapeutic use
Postoperative Complications - blood
Postoperative Complications - etiology
Postoperative Complications - prevention & control
Stents
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
Treatment Outcome
Troponin I - blood
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Summary:The object of this study was to determine the effect of pre-treatment with clopidogrel in patients undergoing elective stent implantation. The treatment of patients with adenosine diphosphate receptor blockers after percutaneous coronary intervention (PCI) with stent implantation has been shown to decrease the incidence of subacute stent thrombosis. Furthermore, non-randomized studies on pre-treatment with clopidogrel among patients undergoing stent implantation have suggested a reduction in myocardial damage and clinical events. The effect of pre-treatment with clopidogrel has been studied in only a few randomized trials. In a randomized trial, three days of pre-treatment with clopidogrel was compared with standard post-procedural treatment in 203 patients undergoing elective stent implantation. The primary end point was a rise in troponin I or creatine kinase-MB fraction (CK-MB) serum levels at 6 to 8 and 16 to 24 h after PCI. Secondary end points were death, stroke, myocardial infarction, coronary bypass grafting, repeated PCI, and subacute stent thrombosis at one and six months after PCI. No difference was found between non–pre-treated and pre-treated patients in the post-procedural elevation of troponin I (42 [43.3%] vs. 48 [51.1%], respectively, p = 0.31) or CK-MB (6 [6.3%] vs. 7 [7.4%], respectively, p = 0.78). Adjustment for possible confounding factors did not change these findings. Patient follow-up at one and six months showed no significant difference between the treatment groups in death, stroke, myocardial infarction, coronary artery bypass grafting, repeated PCI, or subacute stent thrombosis. In this randomized study, no beneficial effect of pre-treatment with clopidogrel on post-procedural elevation of troponin I and CK-MB or on clinical events after one and sixth months could be demonstrated. The study suggests that among patients with stable coronary syndromes in whom coronary stent implantation is planned, pre-treatment may not be beneficial in reducing early myocardial damage.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2004.02.056