Outcome comparison of 600- and 300-mg loading doses of clopidogrel in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Results from the ARMYDA-6 MI (antiplatelet therapy for reduction of myocardial damage during angioplasty-myocardial infarction) randomized study

Giuseppe Patti, György Bárczi, Dejan Orlic, Fabio Mangiacapra, Giuseppe Colonna, Vincenzo Pasceri, Emanuele Barbato, B. Merkely, I. Édes, Miodrag Ostojic, William Wijns, Germano Di Sciascio

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to compare 600- and 300-mg clopidogrel loading doses in patients with ST-segment elevation myocardial infarction (STEMI). Background: Given the high thrombotic risk of patients with STEMI, greater platelet inhibition may improve outcome in those patients receiving percutaneous coronary intervention (PCI). Although observational data suggest that pretreatment with a 600-mg clopidogrel loading dose may be more effective than the 300-mg regimen in primary PCI, this hypothesis has never been tested in a randomized study. Methods: A total of 201 patients undergoing primary PCI for STEMI randomly received a 600-mg (n = 103) or 300-mg (n = 98) clopidogrel loading dose before the procedure. The primary endpoint was the evaluation of the infarct size, defined as the area under the curve of cardiac markers. Results: Infarct size was significantly lower in the high-dose regimen: median creatine kinase-myocardial band 2,070 ng/ml (interquartile range [IQR]: 815 to 2,847 ng/ml) versus 3,049 ng/ml (IQR: 1,050 to 7,031 ng/ml) in the 300-mg group, p = 0.0001; troponin-I 255 ng/ml (IQR: 130 to 461 ng/ml) versus 380 ng/ml (IQR: 134 to 1,406 ng/ml), p <0.0001. In the 600-mg arm, Thrombolysis In Myocardial Infarction flow grade

Original languageEnglish
Pages (from-to)1592-1599
Number of pages8
JournalJournal of the American College of Cardiology
Volume58
Issue number15
DOIs
Publication statusPublished - Oct 4 2011

Fingerprint

clopidogrel
Percutaneous Coronary Intervention
Angioplasty
Myocardial Infarction
MB Form Creatine Kinase
Troponin I
Therapeutics
Area Under Curve
Blood Platelets
ST Elevation Myocardial Infarction

Keywords

  • acute myocardial infarction
  • clopidogrel
  • infarct size
  • outcome
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcome comparison of 600- and 300-mg loading doses of clopidogrel in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction : Results from the ARMYDA-6 MI (antiplatelet therapy for reduction of myocardial damage during angioplasty-myocardial infarction) randomized study. / Patti, Giuseppe; Bárczi, György; Orlic, Dejan; Mangiacapra, Fabio; Colonna, Giuseppe; Pasceri, Vincenzo; Barbato, Emanuele; Merkely, B.; Édes, I.; Ostojic, Miodrag; Wijns, William; Di Sciascio, Germano.

In: Journal of the American College of Cardiology, Vol. 58, No. 15, 04.10.2011, p. 1592-1599.

Research output: Contribution to journalArticle

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title = "Outcome comparison of 600- and 300-mg loading doses of clopidogrel in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: Results from the ARMYDA-6 MI (antiplatelet therapy for reduction of myocardial damage during angioplasty-myocardial infarction) randomized study",
abstract = "Objectives: The purpose of this study was to compare 600- and 300-mg clopidogrel loading doses in patients with ST-segment elevation myocardial infarction (STEMI). Background: Given the high thrombotic risk of patients with STEMI, greater platelet inhibition may improve outcome in those patients receiving percutaneous coronary intervention (PCI). Although observational data suggest that pretreatment with a 600-mg clopidogrel loading dose may be more effective than the 300-mg regimen in primary PCI, this hypothesis has never been tested in a randomized study. Methods: A total of 201 patients undergoing primary PCI for STEMI randomly received a 600-mg (n = 103) or 300-mg (n = 98) clopidogrel loading dose before the procedure. The primary endpoint was the evaluation of the infarct size, defined as the area under the curve of cardiac markers. Results: Infarct size was significantly lower in the high-dose regimen: median creatine kinase-myocardial band 2,070 ng/ml (interquartile range [IQR]: 815 to 2,847 ng/ml) versus 3,049 ng/ml (IQR: 1,050 to 7,031 ng/ml) in the 300-mg group, p = 0.0001; troponin-I 255 ng/ml (IQR: 130 to 461 ng/ml) versus 380 ng/ml (IQR: 134 to 1,406 ng/ml), p <0.0001. In the 600-mg arm, Thrombolysis In Myocardial Infarction flow grade",
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T1 - Outcome comparison of 600- and 300-mg loading doses of clopidogrel in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

T2 - Results from the ARMYDA-6 MI (antiplatelet therapy for reduction of myocardial damage during angioplasty-myocardial infarction) randomized study

AU - Patti, Giuseppe

AU - Bárczi, György

AU - Orlic, Dejan

AU - Mangiacapra, Fabio

AU - Colonna, Giuseppe

AU - Pasceri, Vincenzo

AU - Barbato, Emanuele

AU - Merkely, B.

AU - Édes, I.

AU - Ostojic, Miodrag

AU - Wijns, William

AU - Di Sciascio, Germano

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N2 - Objectives: The purpose of this study was to compare 600- and 300-mg clopidogrel loading doses in patients with ST-segment elevation myocardial infarction (STEMI). Background: Given the high thrombotic risk of patients with STEMI, greater platelet inhibition may improve outcome in those patients receiving percutaneous coronary intervention (PCI). Although observational data suggest that pretreatment with a 600-mg clopidogrel loading dose may be more effective than the 300-mg regimen in primary PCI, this hypothesis has never been tested in a randomized study. Methods: A total of 201 patients undergoing primary PCI for STEMI randomly received a 600-mg (n = 103) or 300-mg (n = 98) clopidogrel loading dose before the procedure. The primary endpoint was the evaluation of the infarct size, defined as the area under the curve of cardiac markers. Results: Infarct size was significantly lower in the high-dose regimen: median creatine kinase-myocardial band 2,070 ng/ml (interquartile range [IQR]: 815 to 2,847 ng/ml) versus 3,049 ng/ml (IQR: 1,050 to 7,031 ng/ml) in the 300-mg group, p = 0.0001; troponin-I 255 ng/ml (IQR: 130 to 461 ng/ml) versus 380 ng/ml (IQR: 134 to 1,406 ng/ml), p <0.0001. In the 600-mg arm, Thrombolysis In Myocardial Infarction flow grade

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