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Clopidogrel pretreatment before primary percutaneous coronary stenting in patients with acute ST-segment elevation myocardial infarction: comparison of high loading dose (600 mg) versus low loading dose (300 mg)

 Jae-Hun Jung  ;  Pil-Ki Min  ;  Sang-Hak Lee  ;  Chong Won Sung  ;  Seonghoon Choi  ;  Jung Rae Cho  ;  Namho Lee  ;  Ki Hyun Byun 
 CORONARY ARTERY DISEASE, Vol.20(2) : 150-154, 2009 
Journal Title
Issue Date
Aged ; Angioplasty, Balloon, Coronary/adverse effects ; Angioplasty, Balloon, Coronary/instrumentation* ; Angioplasty, Balloon, Coronary/mortality ; Coronary Artery Disease/drug therapy* ; Coronary Artery Disease/mortality ; Coronary Artery Disease/therapy* ; Drug Administration Schedule ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Infarction/prevention & control ; Platelet Aggregation Inhibitors/administration & dosage* ; Retrospective Studies ; Stents* ; Stroke/etiology ; Stroke/prevention & control ; Ticlopidine/administration & dosage ; Ticlopidine/analogs & derivatives* ; Time Factors ; Treatment Outcome
clopidogrel ; myocardial infarction ; percutaneous transluminal ; coronary angioplasty
BACKGROUND: Aggressive platelet inhibition is crucial to reduce myocardial injury and early cardiac events after coronary intervention. As compared with the conventional 300-mg dose, pretreatment with a 600-mg loading dose of clopidogrel significantly reduced periprocedural myocardial infarction (MI) in patients undergoing percutaneous coronary intervention (PCI). We investigated that the advantage of the 600-mg dose in inhibiting platelet aggregation more rapidly than the 300-mg dose may actually have special value for acute ST-segment elevation MI patients.

METHODS: A total of 171 patients with ST-segment elevation MI underwent primary PCI. A 600-mg (n=73) or 300-mg (n=98) loading regimen of clopidogrel was given before the procedure. We did a follow-up of all patients clinically for 30 days after coronary intervention. the primary endpoint was the 30-day occurrence of death, MI, urgent revascularization, or stroke.

RESULTS: the primary endpoint occurred in 1.4% (1 of 73) of patients in the high dose versus 11.2% (11 of 98) of those in the conventional loading dose group (P=0.013). Death, recurrent MI, urgent revascularization, and stroke were lower in patients treated with the high dose of clopidogrel compared with conventional dose. Safety endpoints were similar in the two groups.

CONCLUSION: Pretreatment with a 600-mg loading dose of clopidogrel before the procedure is safe and, as compared with the conventional 300-mg dose, significantly reduces recurrent MI and urgent revascularization in patients with primary PCI.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Min, Pil Ki(민필기) ORCID logo https://orcid.org/0000-0001-7033-7651
Lee, Nam Ho(이남호)
Lee, Sang Hak(이상학) ORCID logo https://orcid.org/0000-0002-4535-3745
Jung, Jae Hun(정재헌)
Cho, Jung Rae(조정래)
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