Lack of efficacy of ticlopidine pre-treatment in the reduction of troponin I release following percutaneous intervention in stable angina patients
Abstract
Anti-platelet therapy reduces postprocedural cardiac events in patients referred to percutaneous coronary intervention. The object of this study was to determine the effect of pre-treatment with ticlopidine plus aspirin compared to aspirin alone.
Prospectively collected data on 360 consecutive patients with stable angina pectoris or evidence of inducible myocardial ischemia were analyzed. In a non-randomized trial, three days of pre-treatment with ticlopidine plus aspirin was compared with standard post-procedural ticlopidine therapy started one hour after percutaneous intervention.
The primary end point was the incidence of pathological troponin I (TnI) release 24 hours after procedure. The secondary end point was the incidence of death, myocardial infarction and revascularization at 21-month follow-up.
A pathological rise of TnI was found in 16 pts. (13%) pre-treated with ticlopidine and 27 pts. (11%) in those non-pre-treated with ticlopidine (p = 0.84). Of the patients experiencing a post-procedural myocardial infarction, those pre-treated with ticlopidine had a non-significant difference in TnI elevation compared with those not receiving ticlopidine pre-PCI [median: 4 ng/mL (3.1-8.3) vs 4.3 ng/mL (2.1-12.3); p = 0.39].
Analyses were repeated with adjustment for significant baseline variables, which did not change the findings. Among the 106 patients (85%) who had received pre-procedural ticlopidine therapy and had available follow-up data, 24 (23%) experienced a secondary end point; among the 190 patients (81%) who had not received pre-PCI therapy and had available followed-up data, 37 (19%) experienced a secondary end point [p = 0.62; (OR 0.83; 95% CI 0.46 to 1.48)].
In stable angina pectoris patients, we did not detect a significant reduction in myocardial injury in patients pre-treated with aspirin plus ticlopidine compared to aspirin alone. This result persisted in long-term follow-up.
Although our results are suggestive, a large, randomized clinical trial evaluating the benefit of ticlopidine pre-treatment prior to PCI in stable angina patients would be needed to verify our results