THE DURATION OF PRETREATMENT WITH TICLOPIDINE PRIOR TO STENTING IS ASSOCIATED WITH THE RISK OF PROCEDURE-RELATED NON-Q-WAVE MYOCARDIAL INFARCTIONS

Objectives. This study sought to determine whether the duration of pre treatment with the adenosine diphosphate receptor antagonist ticlopidi ne prior to intracoronary stenting is associated with the incidence of procedure-related non-Q-wave myocardial dial infarctions (MIs). Backg round. Dual antiplatelet therapy with ticlopidine and aspirin is routi nely used with stenting, although ticlopidine is commonly not begun un til the day of the procedure. Periprocedural MIs are at least partiall y platelet-dependent events. As the maximal platelet inhibitory effect s of this drug take 2 to 3 days to be realized, we hypothesized that l onger treatment prior to stenting would be associated with lower rates of procedure-related MIs. Methods. We reviewed outcomes in 175 consec utive patients treated with ticlopidine prior to stenting at the Cleve land Clinic Foundation. Those patients with an elevation in creatine k inase above our laboratory normal (>210 IU/L) with greater than or equ al to 4% MB fraction on routine evaluation were defined as having a no n-Q-wave (MIs). Results. There were 28 patients (16%) who had a non-Q- wave MI. Longer duration of ticlopidine pretreatment was strongly asso ciated with a lower incidence of procedure-related non-Q-wave MIs (dur ation of pretreatment <1 day, 29% had MI; 1 to 2 days, 14%; greater th an or equal to 3 days, 5%; chi-square for trend = 9.6; p = 0.002). Tic lopidine pretreatment of greater than or equal to 3 days was associate d with a significant reduction in the risk of non-Q-wave MI (unadjuste d odds ratio 0.18, 95% confidence interval = 0.04 to 0.78, p = 0.01) c ompared with pretreatment of <3 days. Conclusions. Among patients unde rgoing intracoronary stenting, beginning ticlopidine therapy several d ays prior to the procedure is associated with a reduced risk of proced ural non-Q-wave MIs. (C) 1998 by the American College of Cardiology.