Coronary artery diseaseRelation of Low Response to Clopidogrel Assessed With Point-of-Care Assay to Periprocedural Myonecrosis in Patients Undergoing Elective Coronary Stenting for Stable Angina Pectoris
Section snippets
Methods
Patients >18 years old with stable angina or a positive functional study finding with a planned PCI procedure of a de novo lesion in a native coronary artery were prospectively eligible for inclusion. Exclusion criteria were a left ventricular ejection fraction <30%, acute coronary syndrome in the previous month, previous MI in the target vessel–related territory, positive biomarkers before PCI, a platelet count <100,000 G/L, history of bleeding diathesis, chronic total occlusion, intrastent
Results
From May to October 2007, 122 consecutive patients who fulfilled the enrollment criteria were included. Demographic data of the population are presented in Table 1, Table 2. Overall occurrence of PMI was 22% (n = 27) in the entire population. Demographic, clinical, and therapeutic parameters were similar in the groups with and without PMI (Table 1, Table 2). Mean time between loading doses of antiplatelet therapy and blood sampling was 15.7 ± 2.1 hours in the entire population and were similar
Discussion
In the present study, low response to clopidogrel using a point-of-care assay was associated with an increased risk of PMI after elective PCI. Several preprocedural treatment strategies have evolved in an attempt to lower the rate of PMI.17 The concept of clopidogrel pretreatment with a standard loading dose of 300 mg has been validated in large clinical trials.2, 18 However, recent data have suggested the benefit of a higher loading dose of clopidogrel (600 mg) on the level of platelet
Acknowledgment
Assistance of our research nurses team in executing this study is gratefully acknowledged.
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