Use of clopidogrel in the reduction of myocardial damage during percutaneous coronary intervention.
It is estimated that approximately a quarter of patients undergoing coronary intervention may have significant post-procedural creatinine (CK)/creatinine kinase myocardial band (CK-MB) elevations and approximately half may have post-procedural troponin elevations. Current data suggest that periprocedural infarction is associated with short-, intermediate-, and long-term adverse outcomes, most notably mortality. This review examines the role of clopidogrel in decreasing periprocedural myonecrosis following percutaneous coronary intervention (PCI). Clopidogrel is an important pharmacologic agent used to reduce myocardial infarction post-coronary intervention as assessed directly by the evaluation of cardiac biomarkers and indirectly by the evaluation of short-term ischemic events. The optimal dose of clopidogrel is considered to be at least 300 mg given 6 to 15 hours prior to PCI but there is considerable evidence to suggest that a loading dose of 600 mg given 2 to 6 hours prior to PCI may be more efficacious in limiting post-coronary intervention events. The benefit obtained from clopidogrel appears independent of and incremental to that of other antiplatelet and antithrombotic agents used during and after coronary intervention.
Gill Heart Institute, University of Kentucky, Lexington, KY 40536-0200, USA.
Arijit
A
Dasgupta
Debabrata
D
Mukherjee
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D000077144:Clopidogrel; D052279:Creatine Kinase, MB Form / Q000097:blood; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D009336:Necrosis; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D014336:Troponin; D000077144:Clopidogrel; D052279:Creatine Kinase, MB Form; D013988:Ticlopidine