Different clopidogrel loading dose strategies for patients with acute ST-segment elevation myocardial infarction
  
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Key words:clopidogrel  acute ST-segment elevation myocardial infarction  percutaneous coronary intervention  
Author NameAffiliation
WU Jian, YE ShaoQiang  
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Abstract:
      ObjectiveTo compare the short-term efficiency and safety of high (600mg) versus low (300mg) loading doses of clopidogrel in patients with acute ST-segment elevation myocardial infarction (STEMI) before percutaneous coronary intervention (PCI). MethodsFrom August 2006 to Feburary 2008,a total of 131 patients with acute STEMI were randomly divided into two groups. Except age,there was no significant difference in baseline data between the two groups (P>0.05). Two hours before PCI,the patients respectively received 600mg (group A,n=65) and 300mg (group B,n=66) loading dose of clopidogrel administration,followed by the maintenance dose of 75mg/d. After 30-day follow-up,the incidence of major clinical cardiovascular events including death,recurrent myocardial infarction,urgent target vessel revascularization,angina pectoris,stroke,readmission,ST segment resolution two hours after the procedure,cardiac troponin I(cTnI) peak,hemorrhagic events,and adverse reactions were compared between the two groups. ResultsThe baseline data before PCI were not different between the two groups. The incidence of 30-day major clinical cardiovascular events (7.7% vs 19.7%,P<0.05),ST segment resolution two hours after the procedure (70.8% vs 45.5%,P<0.05),and cTnI peak after the procedure 〔(16±3)μg/L vs (22±5)μg/L,P<0.01〕 had significant difference between the two groups. The 30-day hemorrhagic events (9.2% vs 7.6%,P>0.05) and adverse reactions (12.3% vs 10.6%,P>0.05) had no significant difference between the two groups. ConclusionCompared with routine loading dose (300mg),high loading dose (600mg) clopidogrel pre-treatment can significantly improve the short term outcome of the patients with acute STEMI undergoing PCI,and the safety was identical.
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