Clopidogrel Versus Adenosin in Non Urgent Percutaneous Coronary Intervention (PCI)
Status:
Unknown status
Trial end date:
2009-09-01
Target enrollment:
Participant gender:
Summary
Percutaneous coronary intervention (PCI) is associated with up to 30% incidence of
myonecrosis, as reflected by elevation of cardiac enzymes in a successful procedure. Apart
from side-branch occlusion, intimal dissection and coronary spasm, a possible aetiology of
myonecrosis after PCI might be distal embolization of atherogenic materials from plaque
disruption causing obstruction of blood flow at capillary level resulting in micro-infarction.
Recent studies have suggested that pretreatment with adenosine in the cath lab and
Clopidogrel and statins greater than 6 hours before may be associated with a reduction in
infarct size after reperfusion therapy for acute myocardial infarction. Whether pretreatment
with adenosine decreases the incidence of myonecrosis in patients undergoing non-urgent PCI
is not fully known. The investigators propose that adenosine-induced hyperaemia can
potentially ameliorate the deleterious effects of distal embolization associated with
non-urgent PCI through dilatation of the microvasculature. Mechanistically, this may reduce
capillary obstruction by facilitating the throughput passage of embolized platelet thrombi
out to the venous end of the coronary circulation, thereby reducing the incidence of post-PCI
myonecrosis. In this prospective, randomized, open-label study, the investigators evaluated
the incidence of myonecrosis after non-urgent PCI with a treatment with intracoronary
adenosine compared with pretreatment of loading dose of Clopidogrel 300/600 mg >/< 6 hours.