[Influence of the double antiplatelet therapy on patency of the occluded artery after acute myocardial infarction with ST-segment elevation].
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.
Radojković
Danijela Dordević
DD
Klinicki centar, Klinika za kardiologiju, 18 000 Nis, Srbija.
Perisić
Zoran
Z
Tomasević
Miloje
M
Pavlović
Milan
M
Apostolović
Svetlana
S
Janković
Ruzica
R
Damjanović
Miodrag
M
Martinović
Sonja Salinger
SS
Bozinović
Nenad
N
Milenković
Dusan
D
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
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin