Antiplatelet Therapy Approaches for PCI Evaluated

Study finds no significant difference in ischemic outcomes and mortality for two approaches
By Jeff Muise
HealthDay Reporter

FRIDAY, Feb. 12 (HealthDay News) -- Patients who receive a loading dose of clopidogrel just before percutaneous coronary intervention (PCI) have similar ischemic and mortality outcomes to those who receive the antiplatelet therapy well in advance of the procedure (as recommended in professional guidelines), according to research published in the Feb. 1 issue of the American Journal of Cardiology.

Dmitriy N. Feldman, M.D., of Weill Cornell Medical College in New York City, and colleagues analyzed 2004 to 2005 Cornell Angioplasty Registry data on 1,041 patients who had PCI for non-ST-elevation acute coronary syndrome. The researchers analyzed two groups -- a "preangiography clopidogrel therapy" group that had received clopidogrel over time or a clopidogrel loading dose according to the current professional pretreatment guidelines (300 mg at least 12 hours pre-PCI or 600 mg at least two hours pre-PCI), and an "in-laboratory clopidogrel loading" group that received 600 mg less than two hours before PCI (immediately before or after PCI).

After a mean follow-up of 23.8 months, the researchers found that, for the "preangiography" and "in-laboratory" groups, the rates of in-hospital death were 0.4 and 0.5 percent, respectively; the rates of myocardial infarction were 7.7 and 6.8 percent, respectively; and the rates of major adverse cardiovascular events were 8.4 and 7.1 percent, respectively. Long-term survival rates were similar (93.4 and 95.8 percent, respectively).

"In conclusion, treatment with a 600-mg loading dose less than 2 hours before PCI is associated with similar short-term ischemic outcomes and long-term mortality compared to the currently recommended clopidogrel pretreatment regimen," the authors write.

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