ORIGINAL ARTICLESurvival Benefit With Concomitant Clopidogrel and Glycoprotein IIb/IIIa Inhibitor Therapy at Ad Hoc Percutaneous Coronary Intervention
Section snippets
PATIENTS AND METHODS
The Mayo Clinic PCI Registry prospectively records demographic, clinical, and angiographic data on all patients who undergo PCI. We reviewed PCI procedures performed between March 1, 1998, and December 31, 2006, a period when our standard of practice included administration of clopidogrel (300 mg) to patients receiving an intracoronary stent. All PCIs were performed in the same setting (ad hoc PCI) as the diagnostic angiography procedure, and patients received dual antiplatelet therapy
RESULTS
At the time of PCI, 12,377 patients received clopidogrel. We excluded 2254 patients with an indication for emergency PCI and 246 who declined research authorization and analyzed the remaining 9877 cases designated as elective or urgent procedures (Table 1). Of these patients, 5196 (53%) received a GP IIb/IIIa inhibitor at the time of the PCI. In 4534 of the 5196 (87%), GP IIb/IIIa was not given until during the procedure; in the remaining 13%, GP IIb/IIIa was given before the procedure.
DISCUSSION
Administration of a GP IIb/IIIa inhibitor and dual antiplatelet therapy (aspirin and clopidogrel) was associated with improved 30-day and long-term mortality in patientsundergoing elective or urgent ad hoc PCI. Long-term adjusted mortality benefit was also seen in patients receiving DESs.
Earlier randomized trials and meta-analyses demonstrated survival advantage and reduction in ischemic complications with the addition of a GP IIb/IIIa inhibitor to aspirin and thienopyridine therapy
CONCLUSION
In patients undergoing elective or urgent ad hoc PCI, adding a GP IIb/IIIa inhibitor to dual antiplatelet therapy at the time of PCI was associated with a significantly improved risk-adjusted 30-day and long-term mortality. Patients with DESs also had lower long-term mortality with GP IIb/IIIa inhibitors given at the time of PCI.
Acknowledgments
We acknowledge the excellent statistical programming support of Joshua P. Slusser.
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