Comparison between ticlopidine and clopidogrel in patients with ST-segment elevation myocardial infarction treated with coronary stenting

Summary

Controversy still surrounds the question, which antiplatelet drug should be added to aspirin in patients undergoing coronary stent implantation. The aim of the current study was to compare ticlopidine and clopidogrel in a consecutive series of patients with ST-segment elevation myocardial infarction (STEMI) treated with primary stenting. Our population is represented by 883 consecutive patients with STEMI undergoing primary stenting from April 1997 to October 2001. All clinical, angiographic, and follow-up data were prospectively collected. A total of 523 patients on clopidogrel were compared with 360 patients on ticlopidine after primary stenting. Except for age and statin therapy, no difference in demographic and clinical characteristics was observed between the two groups. Patients on clopidogrel had a higher rate of successful reperfusion (80.7% vs 73.1%, p = 0.008). No difference was observed between the two groups at both 30-day and 1-year follow-up. These data were confirmed after correction for age, successful reperfusion and statin therapy. This study shows no difference in long-term clinical outcome between clopidogrel and ticlopidine as adjunctive antiplatelet therapy in patients with STEMI undergoing stent implantation.

Keywords

Antiplatelet therapy - stenting - primary angioplasty - outcome

• References

• 1 Moussa I, Oetgen M, Roubin G. et al. Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation 1999; 99: 2364-6.
• 2 Berger PB, Bell MR, Rihal CS. et al. Clopidogrel versus ticlopidine after intracoronary stent placement. J Am Coll Cardiol 1999; 34: 1891-4.
• 3 Bertrand ME, Rupprecht HJ, Urban P. et al. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation 2000; 102: 624-9.
• 4 Taniuchi M, Kurz HI, Lasala JM. Randomised comparison of ticlopidine and clopidogrel after intracoronary stent implantation in a broad patient population. Circulation 2001; 104: 539-43.
• 5 Bhatt DL, Bertrand ME, Berger PB. et al. Metaanalysis of randomised and registry comparisons of ticlopidine with clopidogrel after stenting. J Am Coll Cardiol 2002; 39: 9-14.
• 6 Mueller C, Roskamm H, Neumann FJ. et al. A randomised comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary artery stents. J Am Coll Cardiol 2003; 41: 969-73.
• 7 van t’ Hof A, Liem A, Suryapranata H. et al, on behalf of the Zwolle Myocardial Infarction Study Group. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction. Myocardial Blush Grade. Circulation 1998; 97: 2302-6.
• 8 Love BB, Biller J, Gent M. Adverse haematological effects of ticlopidine. Prevention, recognition and management. Drug Saf 1998; 19: 89-98.
• 9 Rinaldi ML, Piana RN, Caputo RP. et al. Is clopidogrel superior to ticlopidine for the prevention of stent thrombosis? Results from a multicenter study (abstr). Circulation 2001; 104 Suppl II 348.
• 10 Hoffmann R, Mintz GS, Dussaillant GR. et al. Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study. Circulation 1996; 94: 1247-54.
• 11 Henriques JP, Zijlstra F, van Hof AW. et al. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation 2003; 107: 2115-9.
• 12 Cannon CP, Gibson CM, Lambrew CT. et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 2000; 283: 2941-7.
• 13 De Luca G, Suryapranata H, Zijlstra F. et al, ZWOLLE Myocardial Infarction Study Group. Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol 2003; 42: 991-7.
• 14 Antoniucci D, Valenti R, Migliorini A. et al. Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty. Am J Cardiol 2002; 89: 1248-52.
• 15 Zijlstra F, de Boer MJ. Primary angioplasty for acute myocardial infarction: the Zwolle approach. Semin Interv Cardiol 1999; 04: 55-8.