Clinical Research in Cardiology

, Volume 97, Issue 3, pp 160–168

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

  • 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
ORIGINAL PAPER

DOI: 10.1007/s00392-007-0603-z

Cite this article as:
Iijima, R., Ndrepepa, G., Mehilli, J. et al. Clin Res Cardiol (2008) 97: 160. doi:10.1007/s00392-007-0603-z

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.

Key words

abciximab acute coronary syndromes clopidogrel percutaneous coronary intervention platelets troponin 

Copyright information

© Steinkopff Verlag Darmstadt 2007

Authors and Affiliations

  • Raisuke Iijima
    • 1
  • Gjin Ndrepepa
    • 1
  • Julinda Mehilli
    • 1
  • Franz-Josef Neumann
    • 3
  • Stefanie Schulz
    • 1
  • Jurriën ten Berg
    • 4
  • Olga Bruskina
    • 1
  • Franz Dotzer
    • 5
  • Josef Dirschinger
    • 2
  • Peter B. Berger
    • 6
  • Albert Schömig
    • 1
    • 2
  • Adnan Kastrati
    • 1
  1. 1.Deutsches HerzzentrumTechnische UniversitätMunichGermany
  2. 2.Medizinische Klinik rechts der IsarTechnische UniversitätMunichGermany
  3. 3.Herz-ZentrumBad KrozingenGermany
  4. 4.St. Antonius ZiekenhuisNieuwegeinThe Netherlands
  5. 5.Klinikum Garmisch-PartenkirchenGarmisch-PartenkirchenGermany
  6. 6.Geisinger Center for Health ResearchDanvilleUSA

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