European Heart Journal Advance Access published online on May 8, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl004
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1 Isala Klinieken, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands
* To whom correspondence should be addressed. 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.
Received October 4, 2005
Revised March 29, 2006
Accepted April 6, 2006
Clinical research
A comparison of dual vs. triple antiplatelet therapy in patients with non-ST-segment elevation acute coronary syndrome: results of the ELISA-2 trial
Saman Rasoul 1,
Jan Paul Ottervanger 1,
Menko-Jan de Boer 1,
Kor Miedema 2,
Jan C.A. Hoorntje 1,
Marcel Gosselink 1,
Felix Zijlstra 3,
Harry Suryapranata 1,
Jan-Henk E. Dambrink 1,
and
Arnoud W.J. van't Hof 1 *
2 Isala Klinieken, locatie Weezenlanden, Department of Clinical Chemistry, Zwolle, The Netherlands
3 University Medical Center Groningen, University of Groningen, The Netherlands
Arnoud W.J. van't Hof, E-mail: v.r.c.derks{at}isala.nl
Abstract 
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