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Cardioprotection by clopidogrel in acute ST-elevated myocardial infarction patients: a retrospective analysis

  • François Roubille
  • Olivier Lairez
  • Nathan Mewton
  • Gilles Rioufol
  • Sylvain Ranc
  • Ingrid Sanchez
  • Thien Tri Cung
  • Meyer Elbaz
  • Christophe Piot
  • Michel Ovize
Original Contribution

Abstract

Antiplatelet agents have been extensively used in acute coronary syndromes and improve clinical outcome in STEMI patients. Previous experimental studies of the impact of antiplatelet agents on infarct size have been equivoqual. We questioned whether clopidogrel might reduce infarct size in STEMI patients, independently of any antithrombotic effect, by activating a post-conditioning-like myocardial protection. We retrospectively analyzed three recent controlled, randomized, proof of concept clinical trials aimed at determining whether PCI post-conditioning might attenuated infarct size in STEMI. We addressed whether clopidogrel (300–600 mg before angioplasty) might have influenced infarct size using a multivariable linear regression analysis with infarct size as the continuous outcome variable and age, clopidogrel and GP IIb/IIIa inhibitors, post-conditioning, area at risk, ischemia time, coronary thrombectomy and final TIMI flow, as covariates. In this population of 88 STEMI patients, ischemic post-conditioning and clopidogrel administration were the only two therapeutic independent predictors of the final infarct size as determined by cardiac enzymes release (p = 0.005 and p < 0.0001, respectively) This retrospective analysis supports the proposal that clopidogrel attenuates lethal reperfusion injury.

Keywords

Infarction Ischemia Reperfusion Clopidogrel 

Notes

Acknowledgments

The authors express their gratitude to all Clinical Research Assistants who have been involved in these post-conditioning trials (V.Prost, I.Sahraoui), as well as to Céline Giraud for statistics. Nathan Mewton was a recipient of a grant from the Fédération Française de Cardiologie. Post-conditioning studies have been supported by grants from the Hospices Civils de Lyon and from the french PHRC (Programme National de Recherche Clinique).

Conflict of interest

None.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • François Roubille
    • 3
    • 4
  • Olivier Lairez
    • 5
  • Nathan Mewton
    • 1
    • 2
  • Gilles Rioufol
    • 1
  • Sylvain Ranc
    • 2
  • Ingrid Sanchez
    • 2
  • Thien Tri Cung
    • 3
    • 4
  • Meyer Elbaz
    • 5
  • Christophe Piot
    • 3
    • 4
  • Michel Ovize
    • 1
    • 2
    • 6
  1. 1.Inserm U1060 (CarMeN)LyonFrance
  2. 2.CIC de Lyon, service d’Exploration Fonctionnelles Cardiovasculaires, Hospices Civils de LyonUniversité Claude Bernard Lyon1LyonFrance
  3. 3.Inserm U661MontpellierFrance
  4. 4.Hopital Arnaud de VilleneuveUniversité de Montpellier I and IIMontpellierFrance
  5. 5.Service de Cardiologie, Hôpital RangueuilUniversity Paul SabatierToulouseFrance
  6. 6.Hôpital Cardiologique et Pneumologique Louis PradelLyon Cedex 03France

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