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J Am Coll Cardiol, 1999; 34:1884-1890 © 1999 by the American College of Cardiology Foundation |
a Prairie Educational and Research Cooperative, Division of Cardiology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
Manuscript received April 2, 1999; revised manuscript received July 27, 1999, accepted August 27, 1999.
Reprint requests and correspondence: Dr. Gregory J. Mishkel, Prairie Cardiovascular Consultants, Ltd., P.O. Box 19420, Springfield, Illinois 62794-9420
pccl{at}fgi.net
OBJECTIVES
We examined the procedural and 30-day clinical outcomes among patients receiving aspirin and either ticlopidine or clopidogrel during coronary stenting.
BACKGROUND
Ticlopidine-plus-aspirin has become standard antiplatelet therapy for the prevention of thrombotic complications after coronary stenting. Clopidogrel has a similar mechanism of action as ticlopidine, but both its efficacy and its safety as a pharmacologic adjunct to coronary stenting have not been well described.
METHODS
This single-center, prospective analysis examined the in-hospital procedural and 30-day clinical outcomes among 875 consecutive patients undergoing coronary stenting who received adjunctive aspirin and either clopidogrel (n = 514; 58.7%) or ticlopidine (n = 361; 41.3%) therapy.
RESULTS
Procedural success rates were similar among the clopidogrel- (99.6%) and ticlopidine-treated patients (99.4%). Subacute stent thrombosis (i.e., >24 h 
30 days) occurred in one clopidogrel-treated (0.2%) and in one ticlopidine-treated (0.3%) patient (p = 0.99). By 30 days following the index procedure, the combined rates of death, nonfatal myocardial infarction and need for target vessel revascularization were similar among patients who received either clopidogrel (2.1%) or ticlopidine (1.4%; p = 0.57) therapy.
CONCLUSIONS
In this analysis the antiplatelet combination therapy of aspirin-plus-clopidogrel was an effective regimen for preventing thrombotic complications and major adverse cardiovascular events among a broad spectrum of patients undergoing coronary artery stenting.
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