Abstract 20764: Efficacy and Safety of Clopidogrel 600mg Administered Prehospital to Improve Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction: Final Results of the Randomized CIPAMI Trial.
Background: The optimal timepoint for the inititation of clopidogrel therapy in patients with ST elevation myocardial infarction has not been studied in randomized trials.
Methods: Patients with STEMI already diagnosed in the pre-hospital phase and scheduled for primary PCI were randomised to 600 mg clopidogrel given in the prehospital phase or 600 mg clopidogrel administered after the diagnostic angiogram. The primary efficacy endpoint was the TIMI 2/3 patency of the infarct-related artery immediately prior to PCI.
Results: We randomised 337 patients with STEMI < 6 hours to prehospital (n=166) versus post-angiography (n=171) clopidogrel loading dose. All patients received 500 mg aspirin and unfractionated heparin in the prehospital phase. A GP IIb/IIIa inhibitor was given to 48% of patients in both groups. The time interval between initiation of clopidogrel therapy and diagnostic angiography was 47 minutes, 297 patients were treated with primary PCI. TIMI 2/3 patency before PCI was not statistically significant different between the groups (49.3% vs. 45.1%). We observed a trend towards a reduction of the combined endpoint death, reinfarction and urgent TVR in the prehospital treated patients (3% vs. 7%, p=0.06). There was no difference in TIMI major bleedings (8.7% vs. 8.6%).
Conclusions: A loading dose of 600 mg clopidogrel given in the prehospital phase in patients with STEMI scheduled for primary PCI is safe, did not increase pre-PCI patency but was associated with a trend towards a reduction in clinical events.
- © 2010 by American Heart Association, Inc.