Abstract 14813: Pre-Treatment With Thienopyridines Reduces The Amount of Myonecrosis in Acute Coronary Syndrome Patients Invasively Managed: Insights from the CHAMPION trials
Introduction: Clopidogrel pretreatment is beneficial in acute coronary syndrome (ACS) patients managed invasively but its effect on the extent of myonecrosis after PCI has not been explored. We investigated if pretreatment affects post-PCI infarct size using the CHAMPION PCI and PLATFORM trials. These 2 trials tested cangrelor, a novel, intravenous P2Y12 inhibitor, against clopidogrel 600 mg and placebo respectively in patients with stable and unstable angina, NSTEMI and STEMI with planned PCI.
Methods: Patients in the CHAMPION trials were included in this analysis if they had at least 1 CK-MB value pre-PCI and at least 3 values post-PCI. Patients with stable angina, those who underwent CABG, and those who died in the first 24 hrs were excluded. Post-PCI infarct size was calculated using the ratio of the observed post-PCI CK-MB peak and the ULN. Associations between thienopyridine pretreatment (defined as maintenance therapy before randomization) and post-PCI infarct size were explored using univariable and multivariable analysis.
Results: Among the 12,626 ACS patients enrolled, 3,748 (30%) were included (median age 61 yrs, 73% males). Among these, 661(18%) were pretreated with a thienopyridine prior to randomization (659 with clopidogrel and 2 with ticlopidine). The CK-MB peak/ULN ratio, was significantly smaller in patients pretreated compared to those not pretreated [1.08 (0.50, 1.99) vs 1.54 (0.80, 4.43); Wilcoxon P value : <.0001]. Also, thienopyridine pretreatment was an independent predictor of a reduced CK-MB peak in multivariable analysis (beta=−0.714, p<.0001; see Table)
Conclusions: In ACS patients, a maintenance treatment with clopidogrel before PCI is associated with a smaller post-PCI infarct size compared to treatment at the time of PCI or after PCI. Using a continuous measure of myonecrosis, the results of this exploratory analysis confirm the beneficial effect of thienopyridine initiation before PCI.
- © 2010 by American Heart Association, Inc.