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ȣ - 500063 26 |
Clopidogrel Treatment Prior to Primary PCI in Patients with STEMI |
한림의대 강남성심병원¹, 관동의대 명지병원² |
정재헌¹, 민필기², 윤성보¹, 이상학¹, 최성훈¹, 변기현², 조덕규², 고종훈², 이남호¹ |
Purpose
Aggressive platelet inhibition is crucial to reduce myocardial injury and early cardiac events after coronary intervention. As compared with the conventional 300-mg dose, pretreatment with a 600-mg loading dose of clopidogrel significantly reduced periprocedural myocardial infarction (MI) in patients undergoing percutaneous coronary intervention (PCI). We investigated that the advantage of the 600-mg dose in inhibiting platelet aggregation more rapidly than the 300-mg dose may actually have special value for STEMI patients.
Methods
From 2004 to 2005, a total of 165 patients with STEMI underwent primary percutaneous coronary stenting. A 600-mg (n=67) or 300-mg (n=98) loading regimen of clopidogrel was given before the procedure. We followed all patients clinically for 30 days after coronary intervention. The primary end point was the 30-day occurrence of death, myocardial infarction, urgent revascularization, or stroke.
Results
The primary end point occurred in 3% (2/67) of patients in the high dose versus 11% (11/98) of those in the conventional loading dose group (p=0.044) and was due entirely to urgent revascularization (p=0.021). Death, recurrent MI, and stroke were lower in patients treated with the high dose of clopidogrel compared with conventional dose without significance. Safety end points were similar in the 2 groups.
Conclusion
Pretreatment with a 600-mg loading dose of clopidogrel before the procedure is safe and, as compared with the conventional 300-mg, significantly reduced urgent revascularization in patients with primary PCI.
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