Email this article Pilot experience with clopidogrel in the treatment of an .ST-elevation acute myocardial infarction
- Authors: Shalaev SV1,2, Vorobyeva NM1,2, Serescheva AK.1,2, Petrik ES1,2, Akinina SA1,2
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Affiliations:
- Филиал НИИ кардиологии Томского научного центра СО РАМН
- Медицинская академия
- Issue: Vol 79, No 6 (2004)
- Pages: 58-62
- Section: Editorial
- URL: https://journals.rcsi.science/0040-3660/article/view/29841
- ID: 29841
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Abstract
Material and methods. A total of 72 patients (48 males and 24 females) admitted to hospital within 6 hours since the onset of acute myocardial infarction (AMI) were divided into three groups. Group 1 and 2 patients (n = 38 and 20, respectively) were given a prehospital stress dose of aspirin (250- 500 mg), group 3 patients (n = 14) received this dose at admission. TLT with streptokinase or actilise (1500000 IU and 100 mg, respectively) was given to all the patients. Before TLT group 2 received a stress dose of clopidogrel (300 mg), after TLT - 75 mg/day. 12-Lead ECG, CFK activity and troponine content examinations were made. The patients were observed for 30 days. The recovery of coronary circulation (CC) was evaluated by dynamics of a total lowering of the elevated ST segment. Results. CC completely recovered 60 min after TLT in 16, 10 and 7% patients of groups 1, 2 and 3, respectively. CC recovered partially in 24, 55 and 7% patients, respectively. In 90 min after TLT partial recovery of CC was observed in 21, 31 and 43%, respectively; in 180 min the effect was absent in 19, 15 and 38%, respectively. 30-Day lethality was 11.1% and was high in group 3. No lethal outcomes were seen in group 2.
Conclusion. It is possible to achieve better myocardial reperfusion after TLT and improve 30-day outcomes in MI patients given combined antithrombocytic therapy.
About the authors
S V Shalaev
Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академияТюмень; Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академия
N M Vorobyeva
Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академияТюмень; Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академия
A Kh Serescheva
Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академияТюмень; Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академия
E S Petrik
Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академияТюмень; Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академия
S A Akinina
Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академияТюмень; Филиал НИИ кардиологии Томского научного центра СО РАМН; Медицинская академия
References
- Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without бТ-segment elevation. N. Engl. J. Med. 2001; 345: 494-502.
- Mehta S., Yusuf S., Peters R. et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001; 358: 527-533.
- Steinhubl S. R., Berger P. В., Mann J. T. Ill et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention. A randomized controlled trial. J. A. M. A. 2002; 288: 2411-2420.
- Schroder R., Wegscheider K., Schroder K. et al. For the INJECT trial group. Extent of early ST segment elevation resolution: a strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens. J. Am. Coll. Cardiol. 1995; 26: 1657-1664.
- Zeymer U., Schroder R., Tebbe U. et al. Non-invasive detection of early infarct vessel patency by resolution of .ST-segment elevation in patients with thrombolysis for acute myocardial infarction. Results of the angiographic substudy of" the Hirudin for improvement of Thrombolysis (HIT)-4 trial. Eur. Heart J. 2001; 22: 769-775.
- Marrow D. A., Antman E. M., Charlesworth A. et al. TIMI risk score for .ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation. An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000; 102: 2031.
- Simoons M. L., Krzeminska-Pacula M., Alonso A. et al. Improved reperfusion and clinical outcome with enoxaparine as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study. Eur. Heart J. 2002; 23: 1282- 1290.
- Savcic M., Hauert J., Bachmann A. et al. Clopidogrel loading dose regimens: kinetic profile of pharmacodynamic response in healthy subjects. Semin. Thromb. Hemost. 1999; 25 (suppl. 2): 15-19.
- Kovac J. D., Gershliclc A. H. Clinical perspective. How should we detect and manage failed thrombolysis? Eur. Heart J. 2001; 22: 450-457.
- Yusuf S., Mehta S. R., Zhao F. et al. Early and late effects of clopidogrel in patients with acute coronary syndromes. Circulation 2003; 107: 966-972.
