Patients with acute coronary syndromes who were pre-treated with the anti-platelet agent clopidogrel before undergoing a procedure such as balloon angioplasty or stent placement had a reduced risk of adverse events if they received the anti-clotting drug abciximab, according to a study that will appear in the April 5 issue of JAMA. The study is being released early online to coincide with its presentation at the American College of Cardiology annual conference.

NonST-segment elevation (a certain pattern on an electrocardiogram) acute coronary syndromes (ACS - a spectrum of conditions involving chest discomfort or other symptoms) are associated with an increased risk of death and are a major reason for hospital admissions. Although percutaneous coronary interventions (PCIs - procedures such as angioplasty or stent placement used to open narrowed coronary arteries) are an established therapeutic approach in high-risk patients presenting with ACS, it is still unclear what the best adjunctive antithrombotic therapies are, according to background information in the article. There is increasing evidence that treatment with clopidogrel prior to PCI prevents postprocedural ischemic complications. It is not known whether the antiplatelet effect provided by 600 mg of clopidogrel eliminates the need for more potent antiplatelet therapies in patients with ACS undergoing PCI.

Adnan Kastrati, M.D., of the Deutsches Herzzentrum, Munich, Germany and colleagues with the ISAR-REACT 2 Trial assessed whether abciximab is a useful therapy in patients with nonST-segment elevation ACS undergoing PCI, even after pretreatment with a 600-mg loading dose of clopidogrel. The randomized, double-blind, placebo-controlled trial included 2,022 patients and was conducted from March 2003 through December 2005. The patients, with nonST-segment elevation ACS undergoing PCI, were assigned to receive either abciximab or placebo. All patients received clopidogrel, 600 mg, at least 2 hou
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Contact: Adnan Kastrati, M.D.
kastrati@dhm.mhn.de
JAMA and Archives Journals
13-Mar-2006

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