Effect of high loading dose of clopidogrel on myocardial microcirculation in patients after primary percutaneous coronary intervention

Abstract

Objective To explore the effect of high loading dose of clopidogrel on myocardial microcirculation in patients with ST segment elevation myocardial infarction（STEMI）after primary percutaneous coronary intervention（PCI）. Methods Sixty-four STEMI patients were divided into 300 mg clopidogrel group（n =32）and 600 mg clopidogrel group（n = 32）randomly. Myocardial blush grades,sum-ST-segment resolution （sumSTR%）,placental growth factor（PIGF）,soluble CD40 ligand（sCD40L）and left ventricular ejection fraction （LVEF%）were compared after PCI. Results There was no significant difference between the two groups in basic clinical or angiographic characteristics before PCI（P〉0. 05）. Compared with the 300 mg clopidogrel group,patients in the 600 mg clopidogrel group had higher percentage of blush grade 3 of infarct related arteris（21.88%vs. 50. 00% ,P 〈0.05）and higher sumSTR%（（70. 90 ±9. 51）% vs.（60. 70 ± 15.06）% ,P 〈0. 05）. There were lower serum PIGF levels（14.37 ± 1.32）ng/L vs.（15. 85 ± 1.71）ng/L,P 〈 0. 05）and sCD40L levels（4. 93 ±0. 71）μg/L vs.（5.68 ± 0. 77）μg/L,P 〈 0.05）in patients in the 600 mg clopidogrel group after PCI. Seven days after PCI,the LVEF was significantly increased in the 600 mg clopidogrel group（70.96 ± 9. 51）% vs.（65. 27 ±9. 85）% ,P 〈 0.05）. Conclusions High loading dose of clopidogrel before primary PCI can improve myocardium microcirculation in patients with STEMI. Key words: Acute myocardial infarction Interventional therapy High loading dose Clopidogrel Microcirculation