Antiplatelet Effect of Thienopyridine (Clopidogrel or Prasugrel) Pretreatment in Patients Undergoing Primary Percutaneous Intervention for ST Elevation Myocardial Infarction

作者：Beigel Roy; Fefer Paul; Rosenberg Nurit; Novikov Ila; Elian Dan; Fink Noam; Segev Amit; Guetta Victor; Hod Hanoch; Matetzky Shlomi^*

来源：American Journal of Cardiology, 2013, 112(10): 1551-1556.

DOI：10.1016/j.amjcard.2013.07.010

Although previous retrospective studies have suggested the clinical benefits of clopidogrel pretreatment in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI), the antiplatelet effect of thienopyridines during a narrow door-to-balloon time frame has not been evaluated. Seventy-nine consecutive patients with STEMI were treated with either 600 mg of clopidogrel (n = 49) or 60 mg of prasugrel (n = 30) loading on admission. All patients underwent PPCI with a door-to-balloon time of 48 +/- 20 minutes. Adenosine diphosphate (ADP) induced platelet aggregation (PA) was determined by light transmission aggregometry before thienopyridine loading, at PPCI, and after 72 hours. Baseline ADP-induced PA was comparable in clopidogrel- and prasugrel-treated patients (79 +/- 10% vs 76 +/- 9%, p = 0.2). Although ADP-induced PA was reduced significantly in both clopidogrel- and prasugrel-treated patients (p <0.01 for both), it was significantly lesser in prasugrel-treated patients (63 +/- 18% vs 74 +/- 12%, p = 0.002). Yet, <50% of the prasugrel-treated patients achieved adequate platelet inhibition (ADP-induced PA <70%) at PPCI. Prasugrel-treated patients, compared with clopidogrel-treated patients, were more likely to have Thrombolysis In Myocardial Infarction myocardial perfusion grade of >= 2 (79% vs 49%, p = 0.01), lower Thrombolysis In Myocardial Infarction frame count (10.2 +/- 5.7 vs 13.6 +/- 7.2, p = 0.03), and a numerically greater incidence of early ST-segment resolution >50% (26 of 30 [87%] vs 35 of 49 [71%], p = 0.1), suggesting better myocardial reperfusion. In conclusion, overall, prasugrel compared with clopidogrel pretreatment resulted in greater platelet inhibition at PPCI, but even with prasugrel, only <50% of the patients achieved early adequate platelet response.

• 出版日期2013-11-15