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首页> 外文期刊>The American heart journal >Timing of clopidogrel loading before percutaneous coronary intervention in clopidogrel-naive patients with stable or unstable angina: a comparison of two strategies.
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Timing of clopidogrel loading before percutaneous coronary intervention in clopidogrel-naive patients with stable or unstable angina: a comparison of two strategies.

机译：初治稳定或不稳定型心绞痛的初次接受氯吡格雷的患者经皮冠状动脉介入治疗前氯吡格雷加载时间：两种策略的比较。

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BACKGROUND: Clopidogrel-naive patients subjected to coronary angiography may be candidates for percutaneous coronary intervention (PCI). Clopidogrel loading with 600 mg at least 2 hours before the procedure is advised for such patients. However, there is no direct evidence that delaying PCI for 2 hours after clopidogrel loading is superior to ad hoc PCI. METHODS: After coronary angiography, clopidogrel-naive patients (N = 199) with stable or unstable angina, candidates for PCI, were loaded with 900 mg of clopidogrel and then randomized to ad hoc PCI (ad hoc group, n = 103) or delayed PCI 2 hours after loading (delayed group, n = 96). Combined primary end point was death/periprocedural myocardial infarction (MI)/stroke/reintervention within 30 days post-PCI. Secondary end points were periprocedural MI; periprocedural creatine kinase-MB elevation >3 x upper limit of normal; any periprocedural increase of creatine kinase-MB, troponin-I, or myoglobin above upper limit of normal; Thrombolysis in Myocardial Infarction flow <3 after PCI; thrombocytopenia with platelet count of <70,000/mL; major bleeding defined according to the Thrombolysis in Myocardial Infarction criteria; and elevation of high-sensitivity C-reactive protein and soluble P selectin. RESULTS: Primary end point occurred in 12.6% ad hoc group versus 15.6% delayed group patients (P = .34). High-sensitivity C-reactive protein increased in both groups post-PCI (analysis of variance P < .0001) without difference between groups (P = .5). Major bleeding occurred in 2.9% ad hoc group versus 3.1% delayed group patients (P = .9). No significant difference was observed in any other secondary end point. CONCLUSIONS: In clopidogrel-naive patients, a strategy of delaying PCI for 2 hours after high-dose clopidogrel loading does not seem to confer any benefit compared to ad hoc PCI.
机译：背景：未接受氯吡格雷的冠状动脉造影患者可能是经皮冠状动脉介入治疗（PCI）的候选人。对于此类患者，建议在手术前至少2小时服用600 mg氯吡格雷。但是，没有直接证据表明氯吡格雷加载后延迟PCI 2小时优于临时PCI。方法：冠状动脉造影后，初治稳定或不稳定型心绞痛的初选氯吡格雷的患者（N = 199），应予PCI的患者，先加用900 mg氯吡格雷，然后随机分为临时PCI（临时组，n = 103）或延迟加载后2小时进行PCI（延迟组，n = 96）。合并后的主要终点是PCI后30天内死亡/围手术期心肌梗死（MI）/中风/再干预。次要终点为术中围手术期心肌梗死;围手术期肌酸激酶-MB升高> 3 x正常上限;肌酸激酶-MB，肌钙蛋白-I或肌红蛋白的任何围手术期增加超过正常上限; PCI后心肌梗塞溶栓<3;血小板减少<70,000 / mL的血小板减少症;根据心肌梗塞溶栓标准定义的严重出血;高敏C反应蛋白和可溶性P选择素的表达结果：特设组的主要终点发生率为12.6％，而延迟组的病人为15.6％（P = 0.34）。 PCI后，两组的高敏C反应蛋白均增加（方差分析P <.0001），两组之间无差异（P = .5）。特别出血组发生率为2.9％，而延迟治疗组为3.1％（P = .9）。在任何其他次级终点均未观察到显着差异。结论：对于未接受氯吡格雷的患者，高剂量氯吡格雷负荷后将PCI延迟2小时的策略与临时PCI相比似乎没有任何益处。

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