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AS-244: Efficacy of Triple Antiplatelet Therapy for Patients with Acute Myocardial Infarction Undergoing Drug-Eluting Stent Implantation
Wednesday, April 22 - Friday, April 24, 2009 (E-Poster Abstract Zone) Conclusion: Adding cilostazol and high-dose clopidogrel may ameliorate low responsiveness to standard-dose clopidogrel in patients with DES implantation.
AS-243 Comparison of Addition of Cilostazol versus Increasing Clopidogrel Dose of Clopidogrel Nonresponders after DrugEluting Stent Implantation. Joo-Yong Hahn, Young Bin Song, Sang-Yup Lee, Seung-Hyuk Choi, Jin-Ho Choi, Sang Hoon Lee, Hyeon-Cheol Gwon. Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Background: Previous studies have reported on triple antiplatelet therapy including cilostazol-enhanced inhibition of platelet P2Y12 signaling compared with standard dual antiplatelet therapy. However, it is uncertain whether the addition of cilostazol is superior to increasing the dose of clopidogrel in clopidogrel nonresponders after drug-eluting stent (DES) implantation. Methods: This was a prospective randomized single-center trial. We enrolled 73 patients who showed poor responsive to clopidogrel on standard dual antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg daily) for more than 2 weeks. Clopidogrel responsive was evaluated using VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA). Patients were considered clopidogrel nonresponders when percent inhibition of P2Y12 reaction units (PRU) was less than 30%. Thirty-five patients were randomly assigned to receive additional cilostazol (aspirin 100 mg ⫹ clopidogrel 75 mg ⫹ cilostazol 100 mg twice daily, group A) and 38 patients to receive increased clopidogrel (aspirin 100 mg ⫹ clopidogrel 150 mg daily, group B). The primary endpoint was percent inhibition of PRU on follow-up VerifyNow P2Y12 assay at 4 weeks after randomization. Secondary endpoints were PRU at follow-up and change in percent inhibition of PRU and PRU. Results: Baseline percent inhibition of PRU and PRU was similar between 2 groups (13.3 ⫾ 10.5% vs 11.7 ⫾ 9.8%, p ⫽ 0.50 and 296 ⫾ 54 vs 287 ⫾ 58, p ⫽ 0.49, respectively). At follow-up, percent inhibition of PRU was significantly greater in group A than in group B (37.0 ⫾ 18.8% vs 27.3 ⫾ 17.1%, p ⫽ 0.02). Change in percent inhibition of PRU was also significantly greater in group A compared with group B (23.6 ⫾ 17.6% vs 15.6 ⫾ 16.8%, p ⫽ 0.04). Follow-up PRU and change in PRU showed a favorable trend toward group A compared with group B but without a significant difference (212 ⫾ 71 vs 245 ⫾ 75, p ⫽ 0.06 and ⫺75 ⫾ 67 vs ⫺51 ⫾ 66, p ⫽ 0.13, respectively). Conclusion: Addition of cilostazol on standard dual antiplatelet therapy improved clopidogrel responsiveness more than increased clopidogrel dose in clopidogrel nonresponders after DES implantation.
AS-244 Efficacy of Triple Antiplatelet Therapy for Patients with Acute Myocardial Infarction Undergoing Drug-Eluting Stent Implantation. Keun-Ho Park, Myung Ho Jeong, Min Goo Lee, Jum Suk Ko, Shin Eun Lee, Won Yu Kang, Soo Hyun Kim, Doo Sun Sim, Nam Sik Yoon, Hyun Ju Youn, Young Joon Hong, Hyung Wook Park, Ju Han Kim, Youngkeun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang. Chonnam National University Hospital, Gwangju, Republic of Korea. Background: It has been known that triple antiplatelet therapy prevents restenosis after drug-eluting stent (DES) implantation. However, few data are available on the efficacy of triple antiplatelet therapy for acute myocardial infarction (AMI). Methods: We analyzed 842 consecutive patients with AMI undergoing DES implantation between November 2005 and April 2008. We compared clinical outcomes between triple antiplatelet therapy (group I,
n ⫽ 699: cilostazol added to aspirin and clopidogrel for at least 1 month) and dual antiplatelet therapy (group II, n ⫽ 143: aspirin and clopidogrel). Results: Mean age was higher (62.0 ⫾ 11.97 vs 59.4 ⫾ 11.89 years, p ⫽ 0.016), creatinine clearance was lower (71.3 ⫾ 30.12 vs 79.6 ⫾ 31.93 ml/min, p ⫽ 0.003), and ST-elevation MI (STEMI) and thrombolysis in myocardial infarction 0 flow were more common (69.4% vs 59.4%, p ⫽ 0.021; 42.6% vs 33.6%, p ⫽ 0.045) in group I. Group I had lower incidence of 6-month target lesion revascularization (TLR) and major adverse cardiac and cerebrovascular events (MACCE) than group II (9.0% vs 16.9% and 11.9% vs 20.6%, p ⫽ 0.006, respectively). In subgroup analysis, lower incidence of 6-month TLR in patients with American College of Cardiology/American Heart Association B2 or C lesions and with non-STEMI (9.4% vs 18.4% and 8.3% vs 17.9%, p ⬍0.05, respectively) were observed in group I than in group II. The rate of bleeding complications was not different between the 2 groups. In multivariate analysis, Killip III or IV and triple antiplatelet therapy were the independent predictors of 6-month MACCE (hazard ratio [HR] ⫽ 2.947; 95% confidence interval [CI] ⫽ 1.560 –5.567, HR ⫽ 0.473; 95% CI ⫽ 0.279 – 0.803). See Figure.
Conclusion: Triple antiplatelet therapy is safe and efficacious and prevents MACCE in patients with AMI, especially in those with complex lesions and non-STEMI.
AS-245 Effects of Differing Administration of Low-Molecular-Weight Heparin on Platelet Activation and Aspirin Intervention. PeiWei Na. Department of Cardiology, The Second Hospital of Hebei Medical University and Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China. Background: To investigate the effects of different administration routes of low-molecular-weight heparin (LMWH) on platelet activation and the roles of conventional aspirin dose (100 mg/d) in the prevention of LMWH-induced platelet activation. Methods: Plasma levels of blood platelet ␣-granule membrane glycoprotein-140 (GMP-140), Von Willebrand factor antigen (vWF:Ag), and platelet membrane glycoprotein IIB/IIIa (GP IIb/IIIa) before and after intravenous or subcutaneous injection of LMWH (dalteparin sodium) were measured by enzyme-linked immunosorbent assay and flow cytometry, respectively. The changes of the earlier-cited indicators after using conventional aspirin dose (100 mg/d) were also measured. Results: The plasma level of GMP-140 and the expression of GP IIb/IIIa after intravenous injection were both significantly higher than the levels before LMWH administration (GMP-140: 5.61 ⫾ 2.10 ng/mL vs 7.19 ⫾ 2.35 ng/mL; GP IIb/IIIa: 6.91% ⫾ 2.93% vs 17.06% ⫾ 14.39%, p ⬍0.05). The expression of GP IIb/IIIa after subcutaneous injection of LMWH, when reaching first dose peak amplitude and steady-state concentration, were also higher than the earlier level, and there were statistical differences when LMWH injection reached steady-state concentration (6.43% ⫾ 4.56% vs 11.17 ⫾ 10.60% vs
The American Journal of Cardiology姞 APRIL 22–24 2009 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster103B
EP O S T E R A B S T R A C T S
AS-243 Comparison of Addition of Cilostazol versus Increasing Clopidogrel Dose of Clopidogrel Nonresponders after DrugEluting Stent Implantation. Joo-Yong Hahn, Young Bin Song, Sang-Yup Lee, Seung-Hyuk Choi, Jin-Ho Choi, Sang Hoon Lee, Hyeon-Cheol Gwon. Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Background: Previous studies have reported on triple antiplatelet therapy including cilostazol-enhanced inhibition of platelet P2Y12 signaling compared with standard dual antiplatelet therapy. However, it is uncertain whether the addition of cilostazol is superior to increasing the dose of clopidogrel in clopidogrel nonresponders after drug-eluting stent (DES) implantation. Methods: This was a prospective randomized single-center trial. We enrolled 73 patients who showed poor responsive to clopidogrel on standard dual antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg daily) for more than 2 weeks. Clopidogrel responsive was evaluated using VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA). Patients were considered clopidogrel nonresponders when percent inhibition of P2Y12 reaction units (PRU) was less than 30%. Thirty-five patients were randomly assigned to receive additional cilostazol (aspirin 100 mg ⫹ clopidogrel 75 mg ⫹ cilostazol 100 mg twice daily, group A) and 38 patients to receive increased clopidogrel (aspirin 100 mg ⫹ clopidogrel 150 mg daily, group B). The primary endpoint was percent inhibition of PRU on follow-up VerifyNow P2Y12 assay at 4 weeks after randomization. Secondary endpoints were PRU at follow-up and change in percent inhibition of PRU and PRU. Results: Baseline percent inhibition of PRU and PRU was similar between 2 groups (13.3 ⫾ 10.5% vs 11.7 ⫾ 9.8%, p ⫽ 0.50 and 296 ⫾ 54 vs 287 ⫾ 58, p ⫽ 0.49, respectively). At follow-up, percent inhibition of PRU was significantly greater in group A than in group B (37.0 ⫾ 18.8% vs 27.3 ⫾ 17.1%, p ⫽ 0.02). Change in percent inhibition of PRU was also significantly greater in group A compared with group B (23.6 ⫾ 17.6% vs 15.6 ⫾ 16.8%, p ⫽ 0.04). Follow-up PRU and change in PRU showed a favorable trend toward group A compared with group B but without a significant difference (212 ⫾ 71 vs 245 ⫾ 75, p ⫽ 0.06 and ⫺75 ⫾ 67 vs ⫺51 ⫾ 66, p ⫽ 0.13, respectively). Conclusion: Addition of cilostazol on standard dual antiplatelet therapy improved clopidogrel responsiveness more than increased clopidogrel dose in clopidogrel nonresponders after DES implantation.
AS-244 Efficacy of Triple Antiplatelet Therapy for Patients with Acute Myocardial Infarction Undergoing Drug-Eluting Stent Implantation. Keun-Ho Park, Myung Ho Jeong, Min Goo Lee, Jum Suk Ko, Shin Eun Lee, Won Yu Kang, Soo Hyun Kim, Doo Sun Sim, Nam Sik Yoon, Hyun Ju Youn, Young Joon Hong, Hyung Wook Park, Ju Han Kim, Youngkeun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang. Chonnam National University Hospital, Gwangju, Republic of Korea. Background: It has been known that triple antiplatelet therapy prevents restenosis after drug-eluting stent (DES) implantation. However, few data are available on the efficacy of triple antiplatelet therapy for acute myocardial infarction (AMI). Methods: We analyzed 842 consecutive patients with AMI undergoing DES implantation between November 2005 and April 2008. We compared clinical outcomes between triple antiplatelet therapy (group I,
n ⫽ 699: cilostazol added to aspirin and clopidogrel for at least 1 month) and dual antiplatelet therapy (group II, n ⫽ 143: aspirin and clopidogrel). Results: Mean age was higher (62.0 ⫾ 11.97 vs 59.4 ⫾ 11.89 years, p ⫽ 0.016), creatinine clearance was lower (71.3 ⫾ 30.12 vs 79.6 ⫾ 31.93 ml/min, p ⫽ 0.003), and ST-elevation MI (STEMI) and thrombolysis in myocardial infarction 0 flow were more common (69.4% vs 59.4%, p ⫽ 0.021; 42.6% vs 33.6%, p ⫽ 0.045) in group I. Group I had lower incidence of 6-month target lesion revascularization (TLR) and major adverse cardiac and cerebrovascular events (MACCE) than group II (9.0% vs 16.9% and 11.9% vs 20.6%, p ⫽ 0.006, respectively). In subgroup analysis, lower incidence of 6-month TLR in patients with American College of Cardiology/American Heart Association B2 or C lesions and with non-STEMI (9.4% vs 18.4% and 8.3% vs 17.9%, p ⬍0.05, respectively) were observed in group I than in group II. The rate of bleeding complications was not different between the 2 groups. In multivariate analysis, Killip III or IV and triple antiplatelet therapy were the independent predictors of 6-month MACCE (hazard ratio [HR] ⫽ 2.947; 95% confidence interval [CI] ⫽ 1.560 –5.567, HR ⫽ 0.473; 95% CI ⫽ 0.279 – 0.803). See Figure.
Conclusion: Triple antiplatelet therapy is safe and efficacious and prevents MACCE in patients with AMI, especially in those with complex lesions and non-STEMI.
AS-245 Effects of Differing Administration of Low-Molecular-Weight Heparin on Platelet Activation and Aspirin Intervention. PeiWei Na. Department of Cardiology, The Second Hospital of Hebei Medical University and Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China. Background: To investigate the effects of different administration routes of low-molecular-weight heparin (LMWH) on platelet activation and the roles of conventional aspirin dose (100 mg/d) in the prevention of LMWH-induced platelet activation. Methods: Plasma levels of blood platelet ␣-granule membrane glycoprotein-140 (GMP-140), Von Willebrand factor antigen (vWF:Ag), and platelet membrane glycoprotein IIB/IIIa (GP IIb/IIIa) before and after intravenous or subcutaneous injection of LMWH (dalteparin sodium) were measured by enzyme-linked immunosorbent assay and flow cytometry, respectively. The changes of the earlier-cited indicators after using conventional aspirin dose (100 mg/d) were also measured. Results: The plasma level of GMP-140 and the expression of GP IIb/IIIa after intravenous injection were both significantly higher than the levels before LMWH administration (GMP-140: 5.61 ⫾ 2.10 ng/mL vs 7.19 ⫾ 2.35 ng/mL; GP IIb/IIIa: 6.91% ⫾ 2.93% vs 17.06% ⫾ 14.39%, p ⬍0.05). The expression of GP IIb/IIIa after subcutaneous injection of LMWH, when reaching first dose peak amplitude and steady-state concentration, were also higher than the earlier level, and there were statistical differences when LMWH injection reached steady-state concentration (6.43% ⫾ 4.56% vs 11.17 ⫾ 10.60% vs
The American Journal of Cardiology姞 APRIL 22–24 2009 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster103B
EP O S T E R A B S T R A C T S