title: A comparison of dual vs. triple antiplatelet therapy in patients with non-ST-segment elevation acute coronary syndrome: results of the ELISA-2 trial.
abstract: OBJECTIVE
  To compare dual vs. triple antiplatelet pre-treatment in patients with non-ST-elevation acute coronary syndrome (NSTE ACS) who were planned for early catheterization.
  
  
  RESULTS
  A total of 328 consecutive patients with NSTE ACS were included and were randomized to pre-treatment with dual (n = 166, aspirin, clopidogrel 600 mg) or triple antiplatelet therapy (n = 162, aspirin, clopidogrel 300 mg, and Tirofiban). The primary endpoint was enzymatic infarct size, defined as cumulative LDH release (LDHQ(48)). Initial TIMI flow of the culprit vessel was a pre-specified secondary endpoint. Angiography was performed in 98% of patients at a median of 23 h after admission. Enzymatic infarct size (median, 25-75%) was 166 (60-349) IU/L in the triple group compared with 193 (75-466) IU/L in the dual group (P = 0.2). Initial TIMI 3 flow of the culprit vessel was significantly more often observed after triple antiplatelet therapy (67 vs. 47%, P = 0.002). At 30 days follow-up, myocardial infarction (MI) occurred in 46% of patients in the triple antiplatelet group, compared with 57% in the dual antiplatelet group, P = 0.052. No significant difference in bleeding was present.
  
  
  CONCLUSIONS
  This study showed that in patients with NSTE ACS, triple antiplatelet pre-treatment was associated with a non-significant reduction in enzymatic infarct size, a significantly better initial perfusion of the culprit vessel, and a trend towards a better survival without death or MI. Further, large-scale studies should be performed to find whether the beneficial trend in favour of triple antiplatelet pre-treatment can be reproduced.
authors: Isala Klinieken, Department of Cardiology, JW Zwolle, The Netherlands.
authors: Saman
authors: S
authors: Rasoul
authors: Jan Paul
authors: JP
authors: Ottervanger
authors: Menko-Jan
authors: MJ
authors: de Boer
authors: Kor
authors: K
authors: Miedema
authors: Jan C A
authors: JC
authors: Hoorntje
authors: Marcel
authors: M
authors: Gosselink
authors: Felix
authors: F
authors: Zijlstra
authors: Harry
authors: H
authors: Suryapranata
authors: Jan-Henk E
authors: JH
authors: Dambrink
authors: Arnoud W J
authors: AW
authors: van 't Hof