European Heart Journal Advance Access originally published online on May 8, 2006
European Heart Journal 2006 27(12):1401-1407; doi:10.1093/eurheartj/ehl004
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
A comparison of dual vs. triple antiplatelet therapy in patients with non-ST-segment elevation acute coronary syndrome: results of the ELISA-2 trial
1 Isala Klinieken, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands
2 Isala Klinieken, locatie Weezenlanden, Department of Clinical Chemistry, Zwolle, The Netherlands
3 University Medical Center Groningen, University of Groningen, The Netherlands
Received 4 October 2005; revised 29 March 2006; accepted 6 April 2006; online publish-ahead-of-print 8 May 2006.
* Corresponding author. Tel: +31 38 4242198; fax: +31 38 4243222. E-mail address: v.r.c.derks{at}isala.nl
Aims To compare dual vs. triple antiplatelet pre-treatment in patients with non-ST-elevation acute coronary syndrome (NSTE ACS) who were planned for early catheterization.
Methods and results A total of 328 consecutive patients with NSTE ACS were included and were randomized to pre-treatment with dual (n=166, aspirin, clopidogrel 600 mg) or triple antiplatelet therapy (n=162, aspirin, clopidogrel 300 mg, and Tirofiban). The primary endpoint was enzymatic infarct size, defined as cumulative LDH release (LDHQ48). Initial TIMI flow of the culprit vessel was a pre-specified secondary endpoint. Angiography was performed in 98% of patients at a median of 23 h after admission. Enzymatic infarct size (median, 25–75%) was 166 (60–349) IU/L in the triple group compared with 193 (75–466) IU/L in the dual group (P=0.2). Initial TIMI 3 flow of the culprit vessel was significantly more often observed after triple antiplatelet therapy (67 vs. 47%, P=0.002). At 30 days follow-up, myocardial infarction (MI) occurred in 46% of patients in the triple antiplatelet group, compared with 57% in the dual antiplatelet group, P=0.052. No significant difference in bleeding was present.
Conclusion This study showed that in patients with NSTE ACS, triple antiplatelet pre-treatment was associated with a non-significant reduction in enzymatic infarct size, a significantly better initial perfusion of the culprit vessel, and a trend towards a better survival without death or MI. Further, large-scale studies should be performed to find whether the beneficial trend in favour of triple antiplatelet pre-treatment can be reproduced.
Key Words: Non-ST-elevation acute coronary syndrome • Antiplatelet therapy • Myocardial infarct size • TIMI flow
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. H Gershlick Ensuring appropriate use of antiplatelet agents in the treatment of acute coronary syndromes have cardiovascular physicians been given enough grace in getting it right? Heart, February 1, 2008; 94(2): 135 - 137. [Full Text] [PDF]
|
|
|
|
 |
|
 R. P. Giugliano and E. Braunwald The Year in Non ST-Segment Elevation Acute Coronary Syndrome J. Am. Coll. Cardiol., October 2, 2007; 50(14): 1386 - 1395. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Van de Werf Dual antiplatelet therapy in high-risk patients Eur. Heart J. Suppl., August 1, 2007; 9(suppl_D): D3 - D9. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Dudek, A. Dziewierz, B. Chyrchel, L. Polonski, J. Legutko, and J. S. Dubiel Antiplatelet treatment in non-ST-segment elevation acute coronary syndrome patients undergoing percutaneous coronary intervention (ISAR-REACT 2 insight) Eur. Heart J. Suppl., February 1, 2007; 9(suppl_A): A25 - A31. [Abstract] [Full Text] [PDF]
|
|