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(Circulation. 2001;103:1403.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Ticlopidine Pretreatment Before Coronary Stenting Is Associated With Sustained Decrease in Adverse Cardiac Events
Data From the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT) Trial
From the Department of Cardiology, Wilford Hall Medical Center (S.R.S.), Lackland AFB, Tex; and the Department of Cardiology and Joseph J. Jacobs Center for Thrombosis and Vascular Biology (S.G.E., A.M.L., E.J.T.) and the Department of Biostatistics and Epidemiology (K.W.), Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Steven R. Steinhubl, MD, Wilford Hall Medical Center, Department of Cardiology, 2200 Bergquist Dr, Lackland AFB, TX 78236. E-mail steven.steinhubl{at}59MDW.WHMC.AF.MIL
Background—Platelet inhibition at the time of a percutaneous coronary intervention has consistently been shown to decrease the risk of thrombotic adverse events but not restenosis. The role of enhanced antiplatelet protection through pretreatment with the platelet ADP-receptor antagonist ticlopidine in preventing both the early and late complications of coronary stenting has not previously been explored.
Methods and Results—In
the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT)
trial, 
1600 patients were randomized to stenting with either placebo
or abciximab in addition to aspirin and heparin. All stented patients
also received ticlopidine after the procedure, but 58% of these
patients were given ticlopidine before stenting at the discretion of
the investigating physician. Among patients randomized to placebo,
ticlopidine pretreatment was associated with a significant decrease in
the incidence of the composite end point of death, myocardial
infarction, or target vessel revascularization (TVR) at 1 year
(adjusted hazard ratio, 0.73; 95% CI, 0.54 to 0.98;
P=0.036). Ticlopidine
pretreatment did not significantly influence the risk of death or
myocardial infarction in patients randomized to abciximab. Controlling
for patient characteristics and for the propensity of being on
ticlopidine, Cox proportional hazards regression identified ticlopidine
pretreatment as an independent predictor of the need for TVR at 1 year
(hazard ratio, 0.62; 95% CI, 0.43 to 0.89;
P=0.010) in both
placebo-treated and abciximab-treated
patients.
Conclusions—In the EPISTENT trial, among patients randomized to stenting, starting ticlopidine before the percutaneous coronary intervention was associated with a significant decrease in the incidence of the 12-month composite end point for patients not receiving abciximab and the need for TVR among all patients.
Key Words: stents • restenosis • platelets
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