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European Heart Journal Advance Access originally published online on April 17, 2009
European Heart Journal 2009 30(14):1736-1743; doi:10.1093/eurheartj/ehp114
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Influence of different antiplatelet treatment regimens for primary percutaneous coronary intervention on all-cause mortality

Adam Witkowski1,*, Pawel Maciejewski2, Wojciech Wasek2, Lukasz A. Malek1, Maciej Niewada3, Bogumil Kaminski4, Janusz Drzewiecki5, Maciej Kosmider6, Jacek Kubica7, Witold Ruzyllo1, Jan Z. Peruga8, Dariusz Dudek9, Grzegorz Opolski10, Slawomir Dobrzycki11, Robert J. Gil12 on behalf of the STEMI 2003 Registry Collaborators

1 Cardiac Catheterization Laboratory, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
2 Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland
3 Department of Clinical and Experimental Pharmacology, Warsaw Medical University, Warsaw, Poland
4 Division of Decision Analysis and Support, Institute of Econometrics, Warsaw School of Economics, Warsaw, Poland
5 Department of Invasive Cardiology, Silesian Medical University, Katowice, Poland
6 Department of Haemodynamics and Angiography, Radiology Institute, Lódz Medical University, Lódz, Poland
7 Department of Cardiology, Division of Invasive Cardiology, Medical University of Bydgoszcz, Bydgoszcz, Poland
8 Department of Haemodynamics, Lódz Medical University, Lódz, Poland
9 Department of Interventional Cardiology, Jagiellonian University Medical College, Kraków, Poland
10 First Department of Cardiology, Warsaw Medical University, Warsaw, Poland
11 Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
12 Department of Invasive Cardiology, Central Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Poland

Received 18 August 2008; revised 9 February 2009; accepted 4 March 2009; online publish-ahead-of-print 17 April 2009.

* Corresponding author. Tel: +48 22 34 34 127, Fax: +48 22 34 34 506, Email: witkowski{at}hbz.pl

See page 1687 for the editorial comment on this article (doi:10.1093/eurheartj/ehp191)

Aims: The aim of this analysis was to examine the influence of different in-cath-lab antiplatelet regimens for the primary percutaneous coronary intervention (PCI) on all-cause mortality.

Methods and results: The study group consisted of 7193 patients (pts) undergoing primary PCI in 38 centres in 2003 in Poland. All patients received pretreatment with 300 mg of aspirin, 992 pts (14%) received glycoprotein (GP) IIb/IIIa inhibitors, 2690 pts (37%) were treated with 300 mg loading dose of clopidogrel, and 1566 (22%) received combined antiplatelet treatment with both GP IIb/IIIa inhibitors and clopidogrel. Remaining 1945 patients (27%) did not receive GP IIb/IIIa inhibitors or clopidogrel. Primary endpoint of the study was all-cause mortality up to 1 year from ST-segment elevation myocardial infarction (STEMI). One year mortality rates in the four groups were: 10.4%, 9.0%, 9.7%, and 15.3%, respectively. Propensity-adjusted survival analysis showed significant reduction of mortality for combination therapy with GP IIb/IIIa inhibitors and clopidogrel, clopidogrel alone, and GP IIb/IIIa inhibitors alone over aspirin alone. No additive effect on survival was seen for a combination therapy with GP IIb/IIIa inhibitors and clopidogrel in comparison to treatment with clopidogrel alone.

Conclusion: In this large cohort, multicentre STEMI registry in-cath-lab use of GP IIb/IIIa inhibitors and clopidogrel alone or in combination was associated with the reduction of 1 year all-cause mortality in the setting of primary PCI in comparison with aspirin only. However, the use of GP IIb/IIIa inhibitors on top of 300 mg loading dose of clopidogrel did not further reduce mortality.

Key Words: Acute myocardial infarction • Percutaneous coronary intervention • Antiplatelet drugs • Abciximab • Clopidogrel • Survival


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Related articles in EHJ:

Options and outcomes with different antiplatelet strategies during primary percutaneous coronary intervention
Lawrence Rajan and David J. Moliterno
EHJ 2009 30: 1687-1689. [Extract] [Full Text]  



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L. Rajan and D. J. Moliterno
Options and outcomes with different antiplatelet strategies during primary percutaneous coronary intervention
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