Usefulness of clopidogrel in abolishing the increased risk of reinfarction associated with higher platelet counts in patients with ST-elevation myocardial infarction (Results from CLARITY-TIMI 28)

被引:17
作者
Gibson, C. Michael
Ly, Hung Q.
Murphy, Sabina A.
Ciaglo, Lauren N.
Southard, Matthew C.
Stein, Erica B.
Buros, Jacqueline L.
Sabatine, Marc S.
Cannon, Christopher P.
机构
[1] Brigham & Womens Hosp, TIMI Study Grp, Boston, MA 02115 USA
[2] Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA
[3] Harvard Univ, Beth Israel Deaconess Med Ctr, Sch Med, Div Cardiovasc, Boston, MA 02215 USA
关键词
D O I
10.1016/j.amjcard.2006.03.062
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Previous studies have demonstrated an association between increased baseline platelet counts and poorer clinical and angiographic outcomes in patients with ST-elevation myocardial infarction (STEMI). We hypothesized that antiplatelet therapy would mitigate the effect of high baseline platelet counts on clinical outcomes.. Data were obtained. from 3,491 patients with STEMI in the CLARITY-TIMI 28 trial. Patients were categorized into 3 groups based on their baseline platelet counts: < 200 X 10(3)/mu l (group 1), 200 to 300 X 10(3)/mu l (group 2), and > 300 X 10(3)/mu l (group 3). Among placebo-treated patients, reinfarction rates-increased in a stepwise fashion as platelet counts increased (3.6%, 5.4%, and 9.0%, respectively, p for trend = 0.0025). When confounders of high platelet counts and correlates of reinfarction were adjusted for in a multivariate model, high platelet counts remained independently associated with increased rates of reinfarction at 30 days in placebo-treated patients; using group I as a reference group, multivariate odds ratios were 1.45 (95% confidence interval 0.91 to 2.31, p = 0.119) for patients in group 2 and 1.78 (95% confidence interval 1.03 to 3.08, p = 0.038) for patients in group 3. In contrast, among clopidogrel-treated patients, there was no increase in the risk of reinfarction as the platelet count increased (3.2%, 4.1%, and 3.3%, respectively; p for trend = 0.9073, p for interaction = 0.064). In conclusion, among patients with STEMI who are treated with aspirin and a fibrinolytic agent, high platelet counts on presentation are independently associated with increased rates of reinfarction. Clopidogrel therapy abolishes this increase in the risk of reinfarction as platelet counts increase. These data are consistent with a putative role of platelets in reinfarction. (c) 2006 Elsevier Inc.
引用
收藏
页码:761 / 763
页数:3
相关论文
共 7 条
[1]   Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the thrombolysis in myocardial infarction trials [J].
Gibson, CM ;
Karha, J ;
Murphy, SA ;
James, D ;
Morrow, DA ;
Cannon, CP ;
Glugliano, RP ;
Antman, EM ;
Braunwald, E .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 42 (01) :7-16
[2]   Early reinfarction after fibrinolysis - Experience from the Global Utilization of Streptokinase and Tissue plasminogen activator (Alteplase) for occluded coronary arteries (GUSTO I) and Global Use of Strategies to Open occluded coronary arteries (GUSTO III) trials [J].
Hudson, MP ;
Granger, CB ;
Topol, EJ ;
Pieper, KS ;
Armstrong, PW ;
Barbash, GI ;
Guerci, AD ;
Vahanian, A ;
Califf, RM ;
Ohman, EM .
CIRCULATION, 2001, 104 (11) :1229-1235
[3]   INFLUENCE OF PLATELET SIZE ON OUTCOME AFTER MYOCARDIAL-INFARCTION [J].
MARTIN, JF ;
BATH, PMW ;
BURR, ML .
LANCET, 1991, 338 (8780) :1409-1411
[4]   CIRCADIAN VARIATION OF ACUTE MYOCARDIAL-INFARCTION AND THE EFFECT OF LOW-DOSE ASPIRIN IN A RANDOMIZED TRIAL OF PHYSICIANS [J].
RIDKER, PM ;
MANSON, JE ;
BURING, JE ;
MULLER, JE ;
HENNEKENS, CH .
CIRCULATION, 1990, 82 (03) :897-902
[5]   Design and rationale of Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction (CLARITY-TIMI) 28 trial [J].
Sabatine, MS ;
McCabe, CH ;
Gibson, CM ;
Cannon, CP .
AMERICAN HEART JOURNAL, 2005, 149 (02) :227-233
[6]   Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation [J].
Sabatine, MS ;
Cannon, CP ;
Gibson, CM ;
Lopez-Sendon, JL ;
Montalescot, G ;
Theroux, P ;
Claeys, MJ ;
Cools, F ;
Hill, KA ;
Skene, AM ;
McCabe, CH ;
Braunwald, E ;
Braunwald, E ;
Cannon, C ;
Sabatine, M ;
McCabe, C ;
McCagg, A ;
Job, B ;
Gaudin, C ;
Thizon-de Gaulle, I ;
Blumenthal, M ;
Saini, R ;
Delaet, I ;
Townes, L ;
Anhalt, D ;
van Holder, K ;
Skene, A ;
Hill, K ;
Braunwald, E ;
Cannon, C ;
Sabatine, M ;
McCabe, C ;
Job, B ;
Gaudin, C ;
Thizon-de Gaulle, I ;
Blumenthal, M ;
Saini, R ;
Delaet, I ;
Townes, L ;
Skene, A ;
Ardissino, D ;
Aylward, P ;
Bertrand, M ;
Bode, C ;
Budaj, A ;
Claeys, M ;
Dellborg, M ;
Ferreira, R ;
Gershlick, A ;
Huber, K .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 352 (12) :1179-1189
[7]   Association of platelet count with residual thrombus in the myocardial infarct-related coronary artery among patients treated with fibrinolytic therapy for ST-segment elevation acute myocardial infarction [J].
Turakhia, MP ;
Murphy, SA ;
Pinto, TL ;
Antman, EM ;
Giugliano, RP ;
Cannon, CP ;
Braunwald, E ;
Gibson, CM .
AMERICAN JOURNAL OF CARDIOLOGY, 2004, 94 (11) :1406-1410