The study was conducted in five Czech tertiary cardiology centers. Results have surprisingly shown that aggressive non-selective approach to premedication (pre-treating all patients scheduled for coronary angiography) is not superior to a more cautious selective approach.
Background: Anticlotting agent clopidogrel is widely used as pre-treatment before planned percutaneous coronary intervention (PCI) due to the fact that it has been proven to reduce periprocedural ischemic complications (e.g. periprocedural myocardial infarction). However, vast majority of patients in the current interventional cardiology practice do not undergo planned PCI, but rather “ad-hoc“ PCI performed a few minutes after diagnostic coronary angiography (CAG). Whether clopidogrel should be administered as pre-treatment to all patients undergoing elective CAG with the aim to ensure therapeutic levels at the time of possible ad-hoc PCI is not known.
Methods: This randomized trial enrolled 1,028 patients in five participating hospitals in the Czech Republic. All patients underwent elective CAG, i.e. invasive imaging of their coronary arteries. On the day before CAG patients were randomized to group A (“nonselective” - clopidogrel 600 mg to all patients > 6 hours before CAG; n = 513) or group B (“selective” - clopidogrel 600 mg in the cath-lab after CAG, only to patients undergoing subsequent PCI; n = 515). Combined primary end-point was death / periprocedural myocardial infarction / stroke or transient ischemic attack / re-intervention within 7 days. Secondary end-points were troponin elevation, TIMI-flow after PCI, bleeding complications.
Results: Ad-hoc PCI (i.e. PCI immediately following CAG) was performed in 29% of study patients. and bypass surgery (CABG) in 12 % of patients (mostly after >7 days). Medical therapy was indicated in 59% of patients. Primary end-point occurred in 0,8% in both groups (n.s.). Bleeding complications occurred in 3,5% group A patients vs. 1,2% group B (p = 0,02). Periprocedural troponin elevation (i.e. very small infarction as a complication of the procedure) was detected in 2,7% group A vs. 3,0% group B (n.s.).
When only the subgroup of patients who underwent PCI was analyzed, primary end-point occurred in 1,3% group A vs. 2,2% group B (n.s.). Periprocedural troponin elevation was detected in 8,6% (group A) vs. 11,1% (group B, n.s.). Bleeding complications occurred in 7,2% (group A) vs. 0,7% (group B, p = 0,006) and reintervention within 7 days in 0,7% group A vs. 1,5% group B (n.s.).
Conclusion: Routine clopidogrel pretreatment before elective CAG is not justified – it increases the risk of bleeding complications, while the benefit on periprocedural infarction is not significant. Clopidogrel should be given only to patients with known CAG who undergo PCI and this can be done safely in the catheterization laboratory between the two procedures.
ESC Press Office | alfa
Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT
Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont
Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
05.12.2016 | Power and Electrical Engineering
05.12.2016 | Materials Sciences
05.12.2016 | Power and Electrical Engineering