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

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

Research output: Contribution to journalArticle

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Abstract

Background: We sought to determine whether a 600-mg loading dose of clopidogrel reduces myocardial infarct size compared with a 300-mg dose using contrast-enhanced magnetic resonance imaging in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: In 198 patients undergoing primary PCI for STEMI, contrast-enhanced magnetic resonance imaging was performed a median of 7 days after the index event. Infarct size was measured on delayed-enhancement imaging, and area at risk (AAR) was quantified on T2-weighted images. Results: Baseline characteristics were not significantly different between the 600-mg clopidogrel loading group (n = 117) and the 300-mg group (n = 81). The median infarct size was significantly smaller in the 600-mg group than in the 300-mg group (17.3% [8.9%-26.2%] vs 21.7% [12.9%-30.0%], P =.03). Myocardial salvage index ([AAR - infarct size] × 100/AAR) was greater in the 600-mg group than in the 300-mg group (47.7 [33.7-60.9] vs 32.0 [23.6-51.5], P <.01). Patients in the 600-mg group also had a significantly lower extent of microvascular obstruction and smaller number of segments with >75% of infarct transmurality than did those in the 300-mg group. After propensity score matching, the 600-mg group had smaller infarct size and greater myocardial salvage index compared with the 300-mg group. In multivariate analysis, the use of a 600-mg clopidogrel loading dose significantly reduced the risk of a large infarct (odds ratio 0.53, 95% CI 0.29-0.98, P =.04). Conclusions: In patients undergoing primary PCI for STEMI, a 600-mg loading dose of clopidogrel reduced myocardial infarct size and improved myocardial salvage compared with a 300-mg loading dose.

Original languageEnglish (US)
Pages (from-to)500-507
Number of pages8
JournalAmerican Heart Journal
Volume163
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

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clopidogrel
Percutaneous Coronary Intervention
Myocardial Infarction
Magnetic Resonance Imaging
Propensity Score
Multivariate Analysis
Odds Ratio

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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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 Kuen.

In: American Heart Journal, Vol. 163, No. 3, 03.2012, p. 500-507.

Research output: Contribution to journalArticle

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 Kuen. / A high loading dose of clopidogrel reduces myocardial infarct size in patients undergoing primary percutaneous coronary intervention : A magnetic resonance imaging study. In: American Heart Journal. 2012 ; Vol. 163, No. 3. pp. 500-507.
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abstract = "Background: We sought to determine whether a 600-mg loading dose of clopidogrel reduces myocardial infarct size compared with a 300-mg dose using contrast-enhanced magnetic resonance imaging in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: In 198 patients undergoing primary PCI for STEMI, contrast-enhanced magnetic resonance imaging was performed a median of 7 days after the index event. Infarct size was measured on delayed-enhancement imaging, and area at risk (AAR) was quantified on T2-weighted images. Results: Baseline characteristics were not significantly different between the 600-mg clopidogrel loading group (n = 117) and the 300-mg group (n = 81). The median infarct size was significantly smaller in the 600-mg group than in the 300-mg group (17.3{\%} [8.9{\%}-26.2{\%}] vs 21.7{\%} [12.9{\%}-30.0{\%}], P =.03). Myocardial salvage index ([AAR - infarct size] × 100/AAR) was greater in the 600-mg group than in the 300-mg group (47.7 [33.7-60.9] vs 32.0 [23.6-51.5], P <.01). Patients in the 600-mg group also had a significantly lower extent of microvascular obstruction and smaller number of segments with >75{\%} of infarct transmurality than did those in the 300-mg group. After propensity score matching, the 600-mg group had smaller infarct size and greater myocardial salvage index compared with the 300-mg group. In multivariate analysis, the use of a 600-mg clopidogrel loading dose significantly reduced the risk of a large infarct (odds ratio 0.53, 95{\%} CI 0.29-0.98, P =.04). Conclusions: In patients undergoing primary PCI for STEMI, a 600-mg loading dose of clopidogrel reduced myocardial infarct size and improved myocardial salvage compared with a 300-mg loading dose.",
author = "Song, {Young Bin} and Hahn, {Joo Yong} and Gwon, {Hyeon Cheol} and Chang, {Sung A.} and Lee, {Sang Chol} and Choe, {Yeon Hyeon} and Choi, {Seung Hyuk} and Choi, {Jin Ho} and Lee, {Sang Hoon} and Oh, {Jae Kuen}",
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T1 - A high loading dose of clopidogrel reduces myocardial infarct size in patients undergoing primary percutaneous coronary intervention

T2 - A magnetic resonance imaging study

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Gwon, Hyeon Cheol

AU - Chang, Sung A.

AU - Lee, Sang Chol

AU - Choe, Yeon Hyeon

AU - Choi, Seung Hyuk

AU - Choi, Jin Ho

AU - Lee, Sang Hoon

AU - Oh, Jae Kuen

PY - 2012/3

Y1 - 2012/3

N2 - Background: We sought to determine whether a 600-mg loading dose of clopidogrel reduces myocardial infarct size compared with a 300-mg dose using contrast-enhanced magnetic resonance imaging in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: In 198 patients undergoing primary PCI for STEMI, contrast-enhanced magnetic resonance imaging was performed a median of 7 days after the index event. Infarct size was measured on delayed-enhancement imaging, and area at risk (AAR) was quantified on T2-weighted images. Results: Baseline characteristics were not significantly different between the 600-mg clopidogrel loading group (n = 117) and the 300-mg group (n = 81). The median infarct size was significantly smaller in the 600-mg group than in the 300-mg group (17.3% [8.9%-26.2%] vs 21.7% [12.9%-30.0%], P =.03). Myocardial salvage index ([AAR - infarct size] × 100/AAR) was greater in the 600-mg group than in the 300-mg group (47.7 [33.7-60.9] vs 32.0 [23.6-51.5], P <.01). Patients in the 600-mg group also had a significantly lower extent of microvascular obstruction and smaller number of segments with >75% of infarct transmurality than did those in the 300-mg group. After propensity score matching, the 600-mg group had smaller infarct size and greater myocardial salvage index compared with the 300-mg group. In multivariate analysis, the use of a 600-mg clopidogrel loading dose significantly reduced the risk of a large infarct (odds ratio 0.53, 95% CI 0.29-0.98, P =.04). Conclusions: In patients undergoing primary PCI for STEMI, a 600-mg loading dose of clopidogrel reduced myocardial infarct size and improved myocardial salvage compared with a 300-mg loading dose.

AB - Background: We sought to determine whether a 600-mg loading dose of clopidogrel reduces myocardial infarct size compared with a 300-mg dose using contrast-enhanced magnetic resonance imaging in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods: In 198 patients undergoing primary PCI for STEMI, contrast-enhanced magnetic resonance imaging was performed a median of 7 days after the index event. Infarct size was measured on delayed-enhancement imaging, and area at risk (AAR) was quantified on T2-weighted images. Results: Baseline characteristics were not significantly different between the 600-mg clopidogrel loading group (n = 117) and the 300-mg group (n = 81). The median infarct size was significantly smaller in the 600-mg group than in the 300-mg group (17.3% [8.9%-26.2%] vs 21.7% [12.9%-30.0%], P =.03). Myocardial salvage index ([AAR - infarct size] × 100/AAR) was greater in the 600-mg group than in the 300-mg group (47.7 [33.7-60.9] vs 32.0 [23.6-51.5], P <.01). Patients in the 600-mg group also had a significantly lower extent of microvascular obstruction and smaller number of segments with >75% of infarct transmurality than did those in the 300-mg group. After propensity score matching, the 600-mg group had smaller infarct size and greater myocardial salvage index compared with the 300-mg group. In multivariate analysis, the use of a 600-mg clopidogrel loading dose significantly reduced the risk of a large infarct (odds ratio 0.53, 95% CI 0.29-0.98, P =.04). Conclusions: In patients undergoing primary PCI for STEMI, a 600-mg loading dose of clopidogrel reduced myocardial infarct size and improved myocardial salvage compared with a 300-mg loading dose.

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