Comparison of pre-hospital 600 mg or 900 mg vs. peri-interventional 300 mg clopidogrel in patients with ST-elevation myocardial infarction undergoing primary coronary angioplasty. The Load&Go randomized trial

摘要

Data regarding the benefit of clopidogrel pretreatment in primary percutaneous coronary interventions (PCI) are sparse, and the optimal timing of the loading dose is uncertain. The objective of our single-center, prospective, open-label randomized trial was thus to assess whether high doses (600 or 900 mg) of clopidogrel given at first medical contact, as compared with a 300 mg loading dose given in the catheterization laboratory, resulted in a higher degree of optimal myocardial perfusion after primary PCI.We studied 168 patients with STEMI referred from the territorial emergency medical services for primary coronary angioplasty. Patients were randomized to the following arms at first medical contact: clopidogrel 900 mg; 600 mg or no pretreatment. The latter group of patients received a standard loading dose of 300 mg of clopidogrel just prior to primary PCI. All patients also received acetylsalicylic acid 500 mg i.v. and 50001.U. of unfractioned heparin. We used the P2Y12 cartridge of the Verify-Now (Accumetrics Inc., San Diego, California) to evaluate on-clopidogrel platelet reactivity. Informed consent was obtained from each patient and the study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki.