Troponin level and efficacy of abciximab in patients with acute coronary syndromes undergoing early intervention after clopidogrel pretreatment.

Abstract

OBJECTIVE:

We investigated how does troponin level (TnT) affect the benefit achieved by abciximab in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) after pretreatment with a high loading dose of clopidogrel.

METHODS:

The Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT 2) trial included 2,022 patients with non-ST elevation ACS undergoing PCI who were randomized to abciximab or placebo after pretreatment with 600 mg of clopidogrel. The patients were divided into groups with elevated TnT level (n = 1,049) and no elevated TnT level (n = 973). The primary end point of the trial was the composite of death, myocardial infarction and urgent reintervention at 30 days.

RESULTS:

In patients with elevated TnT level the incidence of the primary end point was 13.1% in the abciximab group Vs. 18.3% in the placebo group [relative risk (RR): 0.70; 95% confidence interval (CI), 0.52-0.95, P = 0.02]. The combined incidence of death or myocardial infarction was 12.9% in the abciximab group vs. 17.9% in the placebo group (RR: 0.71; 95% CI, 0.52-0.96, P = 0.03). In contrast, the incidence of the primary end point in patients with no elevated TnT level was identical in both treatment groups (4.6%). The risk of bleeding was not related to TnT level.

CONCLUSIONS:

Baseline troponin level affects the benefit of abciximab in patients with ACS undergoing PCI after pretreatment with a high loading dose of clopidogrel. Abciximab reduces the risk of ischemic events only in patients with ACS and elevated troponin level.

• Authors: Raisuke Iijima, Gjin Ndrepepa, Julinda Mehilli, Franz-Josef Neumann, Stefanie Schulz, Jurriën ten Berg, Olga Bruskina, Franz Dotzer, Josef Dirschinger, Peter B Berger, Albert Schömig, Adnan Kastrati
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 97 Issue 3 Pg. 160-8 (Mar 2008) ISSN: 1861-0684 [Print] Germany
• PMID: 18046527 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Antibodies, Monoclonal
• Biomarkers
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Troponin T
• Clopidogrel
• Ticlopidine
• Abciximab

Topics

• Abciximab
• Acute Coronary Syndrome (blood, drug therapy, mortality)
• Aged
• Antibodies, Monoclonal (therapeutic use)
• Biomarkers (blood)
• Cardiovascular Surgical Procedures
• Clopidogrel
• Electrocardiography
• Female
• Hemorrhage (prevention & control)
• Humans
• Immunoglobulin Fab Fragments (therapeutic use)
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Preoperative Care (methods)
• Survival Analysis
• Ticlopidine (analogs & derivatives, therapeutic use)
• Time Factors
• Treatment Outcome
• Troponin T (blood)