Fefer Paul, Hod Hanoch, Hammerman Haim, Segev Amit, Beinart Roy, Boyko Valentina, Behar Shlomo, Matetzky Shlomi
Department of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Am J Cardiol. 2009 Aug 15;104(4):514-8. doi: 10.1016/j.amjcard.2009.04.013. Epub 2009 Jun 17.
We evaluated the effect and optimal dose of clopidogrel pretreatment in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). The study included 383 consecutive patients with ST-elevation myocardial infarction who had undergone PPCI and were prospectively followed up for a prespecified primary end point of recurrent acute coronary syndrome, stent thrombosis, congestive heart failure, and/or death at 30 days. Of these patients, 217 (57%) received clopidogrel loading before and 166 (43%) after PPCI. A similar number received low (300 mg) and high (600 mg) clopidogrel doses before and after PPCI. Clopidogrel loading before, compared with after, PPCI was associated with a lower incidence of the primary end point (21.7% vs 33.7%, p = 0.008). Clopidogrel pretreatment remained a significant predictor of the primary outcome after adjusting for potential confounders (odds ratio 0.54, 95% confidence interval 0.42 to 0.91). When patients were further stratified into 4 groups according to the timing and dosage of clopidogrel loading, the incidence of the primary outcome was 16% and 27% in those receiving 600 and 300 mg before and 28% and 39% in those receiving 600 and 300 mg after PPCI, respectively (p for trend <0.01). In conclusion, both the timing and the dosage of clopidogrel loading are important and affect the outcome in patients with ST-elevation myocardial infarction undergoing PPCI.
我们评估了氯吡格雷预处理对接受直接经皮冠状动脉介入治疗（PPCI）的ST段抬高型心肌梗死患者的疗效及最佳剂量。该研究纳入了383例连续接受PPCI的ST段抬高型心肌梗死患者，并对其进行前瞻性随访，以观察30天时复发性急性冠状动脉综合征、支架血栓形成、充血性心力衰竭和/或死亡这一预先设定的主要终点事件。在这些患者中，217例（57%）在PPCI前接受了氯吡格雷负荷剂量治疗，166例（43%）在PPCI后接受治疗。PPCI前后接受低剂量（300 mg）和高剂量（600 mg）氯吡格雷的患者数量相似。与PPCI后相比，PPCI前给予氯吡格雷负荷剂量与较低的主要终点事件发生率相关（21.7%对33.7%，p = 0.008）。在调整潜在混杂因素后，氯吡格雷预处理仍然是主要结局的显著预测因素（比值比0.54，95%置信区间0.42至0.91）。当根据氯吡格雷负荷剂量的时间和剂量将患者进一步分为4组时，PPCI前接受600 mg和300 mg氯吡格雷的患者主要结局发生率分别为16%和27%，PPCI后接受600 mg和300 mg氯吡格雷的患者主要结局发生率分别为28%和39%（趋势p<0.01）。总之，氯吡格雷负荷剂量的时间和剂量均很重要，并影响接受PPCI的ST段抬高型心肌梗死患者的结局。
