Antiplatelet effect of 600- and 300-mg loading doses of clopidogrel in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an analysis of the ARMYDA-6 MI (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Myocardial Infarction) Study.

摘要

Platelet reactivity is a well-established determinant of prognosis after percutaneous coronary intervention (PCI) [1]. In patients with ST-segment elevation myocardial infarction (STEMI), platelet reactivity has been shown to predict myocardial necrosis extent [2] and clinical outcomes after primary PCI [3]. To date, the effect of different doses of dopidogrel on peri-procedural platelet reactivity in the setting of STEMI treated with primary PCI is unknown. This is a pre-specified analysis of the ARMYDA-6 MI (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Myocardial Infarction) Study, an international, multicenter, randomized, prospective trial comparing the effect of 600- versus 300-mg clopidogrel loading doses in patients with STEMI undergoing primary PCI [4]. In brief, ARMYDA-6 MI showed that administration of a 600-mg clopidogrel loading dose at first medical contact resulted in a significant reduction of the infarct size, defined as the area under the curve (AUC) of cardiac markers, compared with a 300-mg load; an improvement in angiographic results, residual cardiac function, and 30-day major adverse cardiovascular events was also observed [4].