Pre-treatment with clopidogrel and postprocedure troponin elevation after elective percutaneous coronary intervention

Mark B. Nienhuis; Jan Paul Ottervanger; Kor Miedema; Harry Suryapranata; Menko-Jan de Boer; Jan-Henk E. Dambrink; Jan C.A. Hoorntje; Arnoud W.J. van ’t Hof; Marcel Gosselink; Felix Zijlstra

doi:10.1160/TH05-09-0608

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2006; 95(02): 337-340
DOI: 10.1160/TH05-09-0608

Cardiovascular Biology and Cell Signalling

Schattauer GmbH

Pre-treatment with clopidogrel and postprocedure troponin elevation after elective percutaneous coronary intervention

Mark B. Nienhuis

¹Department of Cardiology, Isala klinieken, Zwolle, The Netherlands

,

Jan Paul Ottervanger

¹Department of Cardiology, Isala klinieken, Zwolle, The Netherlands

,

Kor Miedema

²Department of Clinical Chemistry, Isala klinieken, Zwolle, The Netherlands

,

Harry Suryapranata

¹Department of Cardiology, Isala klinieken, Zwolle, The Netherlands

,

Menko-Jan de Boer

¹Department of Cardiology, Isala klinieken, Zwolle, The Netherlands

,

Jan-Henk E. Dambrink

¹Department of Cardiology, Isala klinieken, Zwolle, The Netherlands

,

Jan C.A. Hoorntje

¹Department of Cardiology, Isala klinieken, Zwolle, The Netherlands

,

Arnoud W.J. van ’t Hof

¹Department of Cardiology, Isala klinieken, Zwolle, The Netherlands

,

Marcel Gosselink

¹Department of Cardiology, Isala klinieken, Zwolle, The Netherlands

,

Felix Zijlstra

³Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands

› Institutsangaben

Abstract

Summary

Elevated troponin after elective percutaneous coronary intervention (PCI) has been associated with a worse prognosis. Pretreatment with clopidogrel may be beneficial in patients undergoing PCI. Therefore, a prospective observational study was conducted to address the potential role of clopidogrel in reducing troponin release after elective PCI. TroponinT was measured 12 hours after elective PCI in 656 patients without elevated troponin before PCI. To assess the independent association between pre-treatment with clopidogrel and increased troponin, multivariate analyses were performed. Mean age of the 656 patients was 63.5 years (SD 10.2), 194 patients (30%) were female and 114 patients (17.4%) had diabetes. In 217 patients (33%) troponin was increased after PCI. Of the 330 patients who were not pre-treated with clopidogrel, 118 patients (34%) had increased troponin after the PCI compared to 99 patients (30%) of the 326 patients who were treated with clopidogrel longer than 24 hours before the procedure (p=0.14). Stratified analyses showed that patients with older age (p=0.03), previous PCI (p=0.013), angina CCS 4 (p=0.03) and multivessel disease (p=0.04) had a significantly lower risk of troponin increase after pre-treatment with clopidogrel compared to patients without pre-treatment. After adjusting for differences in the other variables, patients who were pre-treated with clopidogrel had a significant lower risk of post-PCI increase of troponinT (odds ratio 0.69, 95% confidence interval 0.49–0.99). Pre-treatment with clopidogrel is associated with a significantly lower incidence of increased troponin after elective PCI. Combined with results of other studies, pre-treatment should be advised in patients waiting for elective PCI.

Keywords

Clopidogrel - troponin - percutaneous coronary intervention

Volltext

Referenzen

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