Influence of different antiplatelet treatment regimens for primary percutaneous coronary intervention on all-cause mortality.
OBJECTIVE
The aim of this analysis was to examine the influence of different in-cath-lab antiplatelet regimens for the primary percutaneous coronary intervention (PCI) on all-cause mortality.


RESULTS
The study group consisted of 7193 patients (pts) undergoing primary PCI in 38 centres in 2003 in Poland. All patients received pretreatment with 300 mg of aspirin, 992 pts (14%) received glycoprotein (GP) IIb/IIIa inhibitors, 2690 pts (37%) were treated with 300 mg loading dose of clopidogrel, and 1566 (22%) received combined antiplatelet treatment with both GP IIb/IIIa inhibitors and clopidogrel. Remaining 1945 patients (27%) did not receive GP IIb/IIIa inhibitors or clopidogrel. Primary endpoint of the study was all-cause mortality up to 1 year from ST-segment elevation myocardial infarction (STEMI). One year mortality rates in the four groups were: 10.4%, 9.0%, 9.7%, and 15.3%, respectively. Propensity-adjusted survival analysis showed significant reduction of mortality for combination therapy with GP IIb/IIIa inhibitors and clopidogrel, clopidogrel alone, and GP IIb/IIIa inhibitors alone over aspirin alone. No additive effect on survival was seen for a combination therapy with GP IIb/IIIa inhibitors and clopidogrel in comparison to treatment with clopidogrel alone.


CONCLUSIONS
In this large cohort, multicentre STEMI registry in-cath-lab use of GP IIb/IIIa inhibitors and clopidogrel alone or in combination was associated with the reduction of 1 year all-cause mortality in the setting of primary PCI in comparison with aspirin only. However, the use of GP IIb/IIIa inhibitors on top of 300 mg loading dose of clopidogrel did not further reduce mortality.
Cardiac Catheterization Laboratory, Institute of Cardiology, 04-628 Warsaw, Poland. witkowski@hbz.pl
Adam
A
Witkowski
Pawel
P
Maciejewski
Wojciech
W
Wasek
Lukasz A
LA
Malek
Maciej
M
Niewada
Bogumil
B
Kaminski
Janusz
J
Drzewiecki
Maciej
M
Kosmider
Jacek
J
Kubica
Witold
W
Ruzyllo
Jan Z
JZ
Peruga
Dariusz
D
Dudek
Grzegorz
G
Opolski
Slawomir
S
Dobrzycki
Robert J
RJ
Gil
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011044:Poland / Q000453:epidemiology; D016019:Survival Analysis
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex