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

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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.

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Authors and Affiliations

  1. Deutsches Herzzentrum, Technische Universität, Lazarettstr. 36, 80636, Munich, Germany

    Raisuke Iijima MD, Gjin Ndrepepa MD, Julinda Mehilli MD, Stefanie Schulz MD, Olga Bruskina MD, Albert Schömig MD & Adnan Kastrati MD

  2. Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany

    Josef Dirschinger MD & Albert Schömig MD

  3. Herz-Zentrum, Bad Krozingen, Germany

    Franz-Josef Neumann MD

  4. St. Antonius Ziekenhuis, Nieuwegein, The Netherlands

    Jurriën ten Berg MD

  5. Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany

    Franz Dotzer MD

  6. Geisinger Center for Health Research, Danville, PA, USA

    Peter B. Berger MD

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  1. Raisuke Iijima MD
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  2. Gjin Ndrepepa MD
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  9. Josef Dirschinger MD
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Correspondence to Gjin Ndrepepa MD.

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Iijima, R., Ndrepepa, G., Mehilli, J. et al. Troponin level and efficacy of abciximab in patients with acute coronary syndromes undergoing early intervention after clopidogrel pretreatment. Clin Res Cardiol 97, 160–168 (2008). https://doi.org/10.1007/s00392-007-0603-z

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