title: [Influence of the double antiplatelet therapy on patency of the occluded artery after acute myocardial infarction with ST-segment elevation].
abstract: OBJECTIVE
  Most patients with acute myocardial infarction with ST-segment elevation (STEMI) are still treated with pharmacological reperfusion, which is not always successful. That is the reason for searching possibilities for a better success of reperfusion with adding new antiplatelet drugs. The aim of this study was to investigate weather addition of clopidogrel as a second antiplatelet drug, improves the patency of the infarct-related artery after STEMI.
  
  
  METHODS
  We prospectively enrolled 65 patients, 29-72 years old, hospitalized due to the first STEMI within 6 hours after the on-set of a chest pain. They were treated with a fibrinolytic agent (streptokinase or tissue plasminogen activator--tPA), aspirin, and low molecular heparin (enoxaparin). A group of 50 patients, beside this therapy, received clopidogrel. Coronary angiography was performed between 5th and 10th day of hospitalization to assess for late patency of the infarct-related artery. Infarct-related artery was considered as patent if thrombolysis in myocardial infarction (TIMI) flow grade was 2 or 3, and as occluded if TIMI flow grade was 0 or 1.
  
  
  RESULTS
  In the group of patients who received double antiplatelet therapy (aspirin and clopidogrel), infarct-related artery was occluded in 3 cases (6%); in the group of patients without clopidogrel, infarct-related artery was occluded in 4 patients (26.7%),p < 0.05. There were less frequency of postinfarction angina (6% vs 13.3%), and rarer necessity for rescue percutaneous coronary intervention (4% vs. 13.3%) in the first group, but without statistical significance.
  
  
  CONCLUSIONS
  Adding of clopidogrel to the standard reperfusion pharmacotherapy, as a second antiplatelet drug, increases the number of patients with patent infarct-related artery and the success of reperfusion.
authors.affiliation: Klinicki centar, Klinika za kardiologiju, 18 000 Nis, Srbija.
authors.forename: Danijela Dordević
authors.initials: DD
authors.lastname: Radojković
authors.forename: Zoran
authors.initials: Z
authors.lastname: Perisić
authors.forename: Miloje
authors.initials: M
authors.lastname: Tomasević
authors.forename: Milan
authors.initials: M
authors.lastname: Pavlović
authors.forename: Svetlana
authors.initials: S
authors.lastname: Apostolović
authors.forename: Ruzica
authors.initials: R
authors.lastname: Janković
authors.forename: Miodrag
authors.initials: M
authors.lastname: Damjanović
authors.forename: Sonja Salinger
authors.initials: SS
authors.lastname: Martinović
authors.forename: Nenad
authors.initials: N
authors.lastname: Bozinović
authors.forename: Dusan
authors.initials: D
authors.lastname: Milenković
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D015912:Thrombolytic Therapy; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin