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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Clopidogrel pretreatment in ST-elevation myocardial infarction patients transferred for percutaneous coronary

David M Larson1, Sue Duval, Scott S Sharkey

  • 1Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA. dlarsonmd@visi.com

American Heart Journal
|July 6, 2010
PubMed

Insights

Early clopidogrel pretreatment for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) significantly reduces ischemic complications. This approach, even with longer transfer times, proved safe and effective, without increasing bleeding or mortality risks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Emergency Medicine

Background:

  • Pretreatment with clopidogrel is known to reduce ischemic complications prior to percutaneous coronary intervention (PCI).
  • Limited data exist on the efficacy of clopidogrel pretreatment specifically for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI.
  • This study addresses the knowledge gap concerning early clopidogrel administration in STEMI patients requiring primary PCI.

Purpose of the Study:

  • To evaluate the impact of early clopidogrel pretreatment on ischemic complications in STEMI patients undergoing primary PCI.
  • To assess the safety and effectiveness of clopidogrel pretreatment in a regional STEMI network with varying transfer times.
  • To determine if earlier pretreatment duration correlates with improved patient outcomes.

Main Methods:

  • Prospective data from 2,014 STEMI patients in a regional STEMI network were analyzed.
  • Patients received aspirin, unfractionated heparin, and a 600 mg loading dose of clopidogrel within 15 minutes of diagnosis.
  • Door-to-balloon times were compared between hospitals closer (Zone 1) and farther (Zone 2) from the PCI center.

Main Results:

  • Longer pretreatment duration with clopidogrel was associated with significantly reduced reinfarction/reischemia at 30 days (0.85-0.9%) compared to nontransferred patients (3.2%).
  • Reduced stent thrombosis rates were observed in pretreated patients from Zone 1 and Zone 2 hospitals (0.6%) compared to those treated at the PCI hospital (2.0%).
  • Pretreatment duration exceeding 60 minutes showed a significant reduction in 30-day reinfarction/reischemia (1.0% vs 2.9%).

Conclusions:

  • STEMI patients undergoing primary PCI in a regional network benefit from earlier clopidogrel pretreatment.
  • A 600-mg loading dose of clopidogrel administered early reduces ischemic complications.
  • This strategy is safe, showing no significant increase in mortality or major bleeding.
Abstract

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