Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study.

Content Provider	Semantic Scholar
Author	Patti, Giuseppe Colonna, Giuseppe Pasceri, Vincenzo Pepe, Leonardo Lassandro Montinaro, Antonio Sciascio, Germano Di
Copyright Year	2005
Abstract	BACKGROUND Aggressive platelet inhibition is crucial to reduce myocardial injury and early cardiac events after coronary intervention. Although observational data have suggested that pretreatment with a high loading dose of clopidogrel may be more effective than a conventional dose, this hypothesis has never been tested in a randomized trial. METHODS AND RESULTS A total of 255 patients scheduled to undergo percutaneous coronary intervention were randomized to a 600-mg (n=126) or 300-mg (n=129) loading regimen of clopidogrel given 4 to 8 hours before the procedure. Creatine kinase MB, troponin I, and myoglobin levels were measured at baseline and at 8 and 24 hours after intervention. The primary end point was the 30-day occurrence of death, myocardial infarction (MI), or target vessel revascularization. The primary end point occurred in 4% of patients in the high loading dose versus 12% of those in the conventional loading dose group (P=0.041) and was due entirely to periprocedural MI. Peak values of all markers were significantly lower in patients treated with the 600-mg regimen (P< or =0.038). Safety end points were similar in the 2 arms. At multivariable analysis, the high loading regimen was associated with a 50% risk reduction of MI (OR 0.48, 95% CI 0.15 to 0.97, P=0.044). An incremental benefit was observed in patients randomized to the 600-mg dose who were receiving statins, with an 80% risk reduction. CONCLUSIONS Pretreatment with a 600-mg loading dose of clopidogrel 4 to 8 hours before the procedure is safe and, as compared with the conventional 300-mg dose, significantly reduced periprocedural MI in patients undergoing percutaneous coronary intervention. These results may influence practice patterns with regard to antiplatelet therapy before percutaneous revascularization.
File Format	PDF HTM / HTML
Alternate Webpage(s)	http://circ.ahajournals.org/content/circulationaha/111/16/2099.full.pdf?download=true
Alternate Webpage(s)	http://circ.ahajournals.org/content/circulationaha/111/16/2099.full.pdf
PubMed reference number	15750189v1
Volume Number	111
Issue Number	16
Journal	Circulation
Language	English
Access Restriction	Open
Subject Keyword	Alveolar rhabdomyosarcoma Blood Platelets Cardiomyopathies Cessation of life Creatine Eighty Increment Myocardial Infarction Myocardium Myoglobin Patients Percutaneous Coronary Intervention Schedule (document type) Simvastatin clopidogrel revascularization
Content Type	Text
Resource Type	Article