Document Detail

Quantification of the effect of clopidogrel on enzymatic infarct size related to a percutaneous coronary intervention in patients with acute coronary syndromes: insights from the CHAMPION percutaneous coronary intervention trial.
MedLine Citation:
PMID:  23442944     Owner:  NLM     Status:  Publisher    
OBJECTIVES: Using data from the CHAMPION percutaneous coronary intervention (PCI), we determined the relationship between clopidogrel started at least 5 days before PCI (maintenance of clopidogrel) and PCI-related enzymatic infarct size. BACKGROUND: Clopidogrel is recommended in patients with acute coronary syndrome (ACS) managed with PCI, but its effect on PCI-related myonecrosis in contemporary patients has not been quantified. PATIENTS AND METHODS: Patients with ACS (with or without ST-segment elevation) who underwent PCI and had at least three creatine kinase-MB (CK-MB) samples after PCI were included. Enzymatic infarct size was defined as the peak CK-MB concentration indexed by its upper limit of normal. Associations between maintenance clopidogrel and enzymatic infarct size were explored using multivariable linear regression (with and without missing data imputation) and propensity score analysis using inverse probability weighting. RESULTS: Of 8877 patients randomized, 6327 (71.3%) were included (median age 61 years, 73% male, 13% ACS with ST-segment elevation). Of these 6327 patients, 2015 (31.8%) were on maintenance clopidogrel. After multivariable adjustment, maintenance clopidogrel was associated with a reduction in enzymatic infarct size {β=-0.63; 47% decrease in peak CK-MB [95% confidence interval (CI) 35, 56%]}. Multivariable linear regression with multiple imputations and inverse probability weighting propensity score analysis yielded similar results, with maintenance clopidogrel associated with 44% (95% CI 33, 53%) and 29% (95% CI 24, 33%) infarct size reductions. CONCLUSION: In this subgroup analysis of modern ACS patients, clopidogrel maintenance was independently associated with smaller enzymatic infarct size after PCI. These results are consistent with previous observations suggesting a benefit of clopidogrel on the procedural outcome and quantify this benefit.
Sergio Leonardi; Amanda Stebbins; Renato D Lopes; Yuliya Lokhnygina; Meredith Todd; Deepak L Bhatt; Gregg W Stone; A Michael Lincoff; Harold L Dauerman; C Michael Gibson; Harvey D White; Keyur H Parikh; Luis Gruberg; Howard C Herrmann; Brent T McLaurin; Shaun G Goodman; Kenneth W Mahaffey
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-25
Journal Detail:
Title:  Coronary artery disease     Volume:  -     ISSN:  1473-5830     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of aCardiology bMedicine cBiostatistics and Bioinformatics dClinical Trials Statistics Group, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina eThe Medicines Company, Parsippany, New Jersey fDepartment of Medicine, VA Boston Healthcare System, Harvard Medical School, Brigham and Women's Hospital gDivision of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts hThe Cardiovascular Research Foundation, New York City iDivision of Cardiovascular Medicine, SUNY-Stony Brook University Medical Center, Stony Brook, New York jDepartment of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio kDepartment of Medicine, University of Vermont College of Medicine, Burlington, Vermont lDepartment of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania mAnMed Health, Anderson, South Carolina, USA nFondazione IRCCS Policlinico S. Matteo, Pavia, Italy oGreen Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand pCare Institute of Medical Sciences, Ahmedabad, India qDepartment of Medicine, Division of Cardiology, Canadian Heart Research Center and St Michael's Hospital, Toronto, Ontario, Canada.
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