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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
05:26

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction

Published on: May 28, 2019

Efficacy of clotinab in acute myocardial infarction trial-ST elevation myocardial infarction (ECLAT-STEMI)

Jung-Sun Kim1, Sang-Min Park, Byeong-Keuk Kim

  • 1Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea.

Circulation Journal : Official Journal of the Japanese Circulation Society
|December 8, 2011
PubMed

Insights

Upstream use of clotimab glycoprotein (Gp) IIb/IIIa inhibitor with clopidogrel did not significantly reduce cardiac events in ST-elevation myocardial infarction (STEMI) patients but improved outcomes in high-risk individuals.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Investigated the efficacy and safety of upstream glycoprotein (Gp) IIb/IIIa inhibitor (clotinab) versus provisional use.
  • Utilized 600-mg clopidogrel pretreatment in ST-elevation myocardial infarction (STEMI) patients.

Purpose of the Study:

  • To compare the clinical outcomes of upstream versus provisional GP IIb/IIIa inhibitor administration in STEMI patients.
  • To assess the safety and efficacy of clotinab in conjunction with clopidogrel pretreatment.

Main Methods:

  • Randomized 786 STEMI patients into upstream (n=392) and provisional (n=394) arms.
  • Administered 600-mg clopidogrel pretreatment to all patients in the emergency room.
  • Primary endpoint: 30-day composite of death, nonfatal MI, target vessel revascularization, and stroke.

Main Results:

  • No significant difference in 30-day composite events between upstream (10.2%) and provisional (14.0%) arms (OR 0.70).
  • Higher incidence of major bleeding in the upstream arm (1.5% vs. 0%, P=0.02).
  • Significant reduction in 30-day composite events observed in high-risk patients (Killip class ≥II or GRACE score >140) with upstream clotinab.

Conclusions:

  • Upstream clotinab with clopidogrel loading may not significantly reduce cardiac events post-primary PCI.
  • Upstream clotinab demonstrated potential to improve clinical outcomes specifically in high-risk STEMI patients.
  • Further research may be warranted to define optimal use in specific patient subgroups.
Abstract

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