A high loading dose of clopidogrel reduces myocardial infarct size in patients undergoing primary percutaneous coronary intervention: A magnetic resonance imaging study

Song, Young Bin; Hahn, Joo Yong; Gwon, Hyeon Cheol; Chang, Sung‐A; Lee, Sang‐Chol; Choe, Yeon Hyeon; Choi, Seung Hyuk; Choi, Jin Ho; Lee, Sang Hoon; Oh, Jae K.

doi:10.1016/j.ahj.2011.12.007

Cited by 28 publications

(24 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the prevalence of visible thrombus was higher in the clopidogrel group, TIMI flow grade before PPCI and technical success at PPCI were similar, and the former was adjusted to correct for higher thrombus burden. In addition, all patients receiving clopidogrel had the larger 600‐mg loading dose, which, in a previous retrospective study in 198 patients, was associated with reduced CMR‐derived infarct size and MVO and increased myocardial salvage after PPCI 18. The higher infarct size and MVO incidence occurred despite a weak trend toward greater degree of IRA collateralization, which can attenuate infarct size and MVO,19, 20 in the patients receiving clopidogrel.…”

Section: Discussionmentioning

confidence: 94%

Infarct Size Following Treatment With Second‐ Versus Third‐Generation P2Y ₁₂ Antagonists in Patients With Multivessel Coronary Disease at ST‐Segment Elevation Myocardial Infarction in the CvLPRIT Study

Khan

Greenwood

Nazir

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundThird‐generation P2Y12 antagonists (prasugrel and ticagrelor) are recommended in guidelines on ST‐segment elevation myocardial infarction. Mechanisms translating their more potent antiplatelet activity into improved clinical outcomes versus the second‐generation P2Y12 antagonist clopidogrel are unclear. The aim of this post hoc analysis of the Complete Versus Lesion‐Only PRImary PCI Trial‐CMR (CvLPRIT‐CMR) substudy was to assess whether prasugrel and ticagrelor were associated with reduced infarct size compared with clopidogrel in patients undergoing primary percutaneous coronary intervention.Methods and ResultsCvLPRIT‐CMR was a multicenter, prospective, randomized, open‐label, blinded end point trial in 203 ST‐segment elevation myocardial infarction patients with multivessel disease undergoing primary percutaneous coronary intervention with either infarct‐related artery–only or complete revascularization. P2Y12 inhibitors were administered according to local guidelines. The primary end point of infarct size on cardiovascular magnetic resonance was not significantly different between the randomized groups. P2Y12 antagonist administration was not randomized. Patients receiving clopidogrel (n=70) compared with those treated with either prasugrel or ticagrelor (n=133) were older (67.8±12 versus 61.5±10 years, P<0.001), more frequently had hypertension (49% versus 29%, P=0.007), and tended to have longer symptom‐to‐revascularization time (234 versus 177 minutes, P=0.05). Infarct size (median 16.1% [quartiles 1–3, 10.5–27.7%] versus 12.1% [quartiles 1–3, 4.8–20.7%] of left ventricular mass, P=0.013) and microvascular obstruction incidence (65.7% versus 48.9%, P=0.022) were significantly greater in patients receiving clopidogrel. Infarct size remained significantly different after adjustment for important covariates using both generalized linear models (P=0.048) and propensity score matching (P=0.025).ConclusionsIn this analysis of CvLPRIT‐CMR, third‐generation P2Y12 antagonists were associated with smaller infarct size and lower microvascular obstruction incidence versus the second‐generation P2Y12 antagonist clopidogrel for ST‐segment elevation myocardial infarction.Clinical Trial Registration URL: http://www.isrctn.com/ISRCTN70913605.

show abstract

Section: Discussionmentioning

confidence: 94%

Infarct Size Following Treatment With Second‐ Versus Third‐Generation P2Y ₁₂ Antagonists in Patients With Multivessel Coronary Disease at ST‐Segment Elevation Myocardial Infarction in the CvLPRIT Study

Khan

Greenwood

Nazir

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…This adverse effect of IV morphine was also observed in cases with other P2Y 12 receptor inhibitors including prasugrel [3,6] and ticagrelor [5,6]. It has also been reported that decreased or delayed effects of antiplatelet agents could aggravate myocardial damage or limit myocardial salvage in AMI [16,17]. Because the importance of platelet inhibition cannot be overemphasized in such thrombotic circumstances, there has been a concern that IV morphine would result in reduction in myocardial salvage by impeding the action of P2Y 12 receptor inhibitor in STEMI patients undergoing reperfusion therapy.…”

Section: Discussionmentioning

confidence: 85%

Morphine Does Not Affect Myocardial Salvage in ST-Segment Elevation Myocardial Infarction

et al. 2017

Self Cite

View full text Add to dashboard Cite

Recent studies have proposed intravenous (IV) morphine is associated with delayed action of antiplatelet agents in acute myocardial infarction. However, it is unknown whether morphine results in increased myocardial damage in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated myocardial salvage index (MSI) to determine whether IV morphine affects myocardial injury adversely in STEMI patients undergoing primary PCI. 299 STEMI patients underwent contrast-enhanced magnetic resonance imaging a median of 3 days after PCI. Infarct size was measured on delayed-enhancement imaging, and area at risk was quantified on T2-weighted imaging. MSI was calculated as ‘[area at risk–infarct size] X 100 / area at risk’. IV morphine was administrated in 32.1% of patients. Patients treated with morphine had shorter symptom to balloon time and higher prevalence of Thrombolysis in Myocardial Infarction flow grade 0 or 1. The morphine group showed a trend toward larger MSI and infarct size and significantly greater area at risk than the non-morphine group. After propensity score matching (90 pairs), MSI was similar between the morphine and non-morphine group (46.1% versus 43.5%, P = .11), and infarct size and area at risk showed no difference. In propensity score-matched analysis, IV morphine prior to primary PCI in STEMI patients did not cause adverse impacts on myocardial salvage.

show abstract

“…One eligibly study was found by searching the bibliographies of the included studies and reviews revealed by the database search. Thus, we finally included 10 studies [11][12][13][14][15][16][17][18][19][20] with a total of 2,697 patients: two randomized controlled trials [14,15], six nonrandomized cohort studies [11,13,[16][17][18][19], one case control study [12], and one case series study [20]. Fig 1 shows the PRISMA flow chart [5] summarizing the selection process.…”

Section: Resultsmentioning

confidence: 99%

“…The details of this adjusted model can be found in S4 Table. The results of the risk of bias assessment in individual studies are summarized in S2 Table. In one study [12], the quality is reduced by the retrospective design and the uncertainty whether the dropouts were similarly distributed in the within-study groups. In four other studies [11,15,16,19], the quality is reduced by a short follow-up length of 6 months. We did not find evidence of publication bias across studies in the data on the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement MRI after STEMI by applying Begg and Mazumdar's rank correlation test (z = -1.67, P = 0.097) and Egger's regression test (t = -1.17, P = 0.255) as well as by visually inspecting the created funnel plot for obvious asymmetry (S1 Fig).…”

Section: Resultsmentioning

confidence: 99%

Prognostic value of the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction: A systematic review and meta-regression analysis

Kendziora

Dewey

2020

PLoS ONE

View full text Add to dashboard Cite

In all patients with ST-segment elevation myocardial infarction, risk stratification should be performed before discharge. The measurement of therapy efficiency with magnetic resonance imaging has been proposed as part of the risk assessment, but it has not been adopted widely. This meta-analysis was conducted to summarize published data on the prognostic value of the proportion of salvaged myocardium inside previously ischemic myocardium (myocardial salvage index) measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction. Random and mixed effects models were used for analyzing the data of 10 studies with 2,697 patients. The pooled myocardial salvage index, calculated as the proportion of non-necrotic myocardium inside edematous myocardium measured by T2-weighted and T1-weighted late gadolinium enhancement MRI, was 43.0% (95% confidence interval: 37.4, 48.6). The pooled length of follow-up was 12.3 months (95% confidence interval: 7.0, 17.6). The pooled incidence of major cardiac events during follow-up, defined as cardiac death, nonfatal myocardial infarction, or admission for heart failure, was 10.6% (95% confidence interval: 5.7, 15.5). The applied mixed effects model showed an absolute decrease of 1.7% in the incidence of major cardiac events during follow-up (95% confidence interval: 1.6, 1.9) with every 1% of increase in the myocardial salvage index. The heterogeneity between studies was considerable (τ = 21.3). Analysis of aggregated follow-up data after ST-segment elevation myocardial infarction suggests that the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging provides prognostic information on the risk of major cardiac events, but considerable heterogeneity exists between studies.

show abstract

A high loading dose of clopidogrel reduces myocardial infarct size in patients undergoing primary percutaneous coronary intervention: A magnetic resonance imaging study

Cited by 28 publications

References 22 publications

Infarct Size Following Treatment With Second‐ Versus Third‐Generation P2Y ₁₂ Antagonists in Patients With Multivessel Coronary Disease at ST‐Segment Elevation Myocardial Infarction in the CvLPRIT Study

Infarct Size Following Treatment With Second‐ Versus Third‐Generation P2Y ₁₂ Antagonists in Patients With Multivessel Coronary Disease at ST‐Segment Elevation Myocardial Infarction in the CvLPRIT Study

Morphine Does Not Affect Myocardial Salvage in ST-Segment Elevation Myocardial Infarction

Prognostic value of the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction: A systematic review and meta-regression analysis

Contact Info

Product

Resources

About

A high loading dose of clopidogrel reduces myocardial infarct size in patients undergoing primary percutaneous coronary intervention: A magnetic resonance imaging study

Cited by 28 publications

References 22 publications

Infarct Size Following Treatment With Second‐ Versus Third‐Generation P2Y 12 Antagonists in Patients With Multivessel Coronary Disease at ST‐Segment Elevation Myocardial Infarction in the CvLPRIT Study

Infarct Size Following Treatment With Second‐ Versus Third‐Generation P2Y 12 Antagonists in Patients With Multivessel Coronary Disease at ST‐Segment Elevation Myocardial Infarction in the CvLPRIT Study

Morphine Does Not Affect Myocardial Salvage in ST-Segment Elevation Myocardial Infarction

Prognostic value of the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction: A systematic review and meta-regression analysis

Contact Info

Product

Resources

About

Infarct Size Following Treatment With Second‐ Versus Third‐Generation P2Y ₁₂ Antagonists in Patients With Multivessel Coronary Disease at ST‐Segment Elevation Myocardial Infarction in the CvLPRIT Study

Infarct Size Following Treatment With Second‐ Versus Third‐Generation P2Y ₁₂ Antagonists in Patients With Multivessel Coronary Disease at ST‐Segment Elevation Myocardial Infarction in the CvLPRIT Study