A randomized trial comparing clopidogrel versus ticlopidine therapy in patients undergoing infarct artery stenting for acute myocardial infarction with abciximab as adjunctive therapy.
OBJECTIVE
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).


CONCLUSIONS
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.
Parodi
Guido
G
Division of Cardiology, Careggi Hospital, Florence, Italy. parodiguido@libero.it
Sciagrà
Roberto
R
Migliorini
Angela
A
Memisha
Gentian
G
Moschi
Guia
G
Valenti
Renato
R
Pupi
Alberto
A
Antoniucci
David
D
D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011877:Radionuclide Imaging; D012008:Recurrence; D015607:Stents; D016019:Survival Analysis; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D017211:Treatment Failure
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D000077284:Abciximab