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
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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
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