Troponin level and efficacy of abciximab in patients with acute coronary syndromes undergoing early intervention after clopidogrel pretreatment.
OBJECTIVE
We investigated how does troponin level (TnT) affect the benefit achieved by abciximab in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) after pretreatment with a high loading dose of clopidogrel.


METHODS
The Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT 2) trial included 2,022 patients with non-ST elevation ACS undergoing PCI who were randomized to abciximab or placebo after pretreatment with 600 mg of clopidogrel. The patients were divided into groups with elevated TnT level (n = 1,049) and no elevated TnT level (n = 973). The primary end point of the trial was the composite of death, myocardial infarction and urgent reintervention at 30 days.


RESULTS
In patients with elevated TnT level the incidence of the primary end point was 13.1% in the abciximab group Vs. 18.3% in the placebo group [relative risk (RR): 0.70; 95% confidence interval (CI), 0.52-0.95, P = 0.02]. The combined incidence of death or myocardial infarction was 12.9% in the abciximab group vs. 17.9% in the placebo group (RR: 0.71; 95% CI, 0.52-0.96, P = 0.03). In contrast, the incidence of the primary end point in patients with no elevated TnT level was identical in both treatment groups (4.6%). The risk of bleeding was not related to TnT level.


CONCLUSIONS
Baseline troponin level affects the benefit of abciximab in patients with ACS undergoing PCI after pretreatment with a high loading dose of clopidogrel. Abciximab reduces the risk of ischemic events only in patients with ACS and elevated troponin level.
Deutsches Herzzentrum, Technische Universität, Lazarettstr. 36, 80636, Munich, Germany.
Raisuke
R
Iijima
Gjin
G
Ndrepepa
Julinda
J
Mehilli
Franz-Josef
FJ
Neumann
Stefanie
S
Schulz
Jurriën
J
ten Berg
Olga
O
Bruskina
Franz
F
Dotzer
Josef
J
Dirschinger
Peter B
PB
Berger
Albert
A
Schömig
Adnan
A
Kastrati
D000077284:Abciximab; D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D013504:Cardiovascular Surgical Procedures; D000077144:Clopidogrel; D004562:Electrocardiography; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011300:Preoperative Care / Q000379:methods; D016019:Survival Analysis; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*
D000911:Antibodies, Monoclonal; D015415:Biomarkers; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D020107:Troponin T; D000077144:Clopidogrel; D013988:Ticlopidine; D000077284:Abciximab