Monitoring of antiaggregation therapy effectivity inpatients with acute stemi: Is it really necessary in clinicalpractice?

Abstract

Antiaggregation therapy is the keystone of acute ST elevation myocardial infarction (STEMI) drug treatment; but effectivity of this therapy is not always sufficient. The aim of the study was to determine wheather laboratory monitoring of antiaggregation therapy helps to improve the management of patients with acute STEMI. A pilot prospective study in patients with acute STEMI treated with direct percutaneous coronary intervention (dPCI) of culprit lession. Optic aggregometry was chosen to assess the effectivity of antiaggregation treatment. Samples were taken prior to coronarography (sample 1) as well as at first day after diagnostic procedure (sample 2). MACE (in-stent trombosis, heart failure, in hospital death, all cases mortality, ventricular arrhytmia, needs of repeat revascularization) were sequently monitored. Study group included 22 patients (average age 66 years, 11 men, 11 women), from whom 14 had recieved clopidogrel loding dose and 8 had recieved prasugrel loding dose. In clopidogrel group 11 patients did not reach effective drug activity in first sample and 3 patients did not reach effective drug activity in second sample. While in prasugrel group ineffective antiaggregation was seen just in 1 patient in first sample. In patients with clopidogrel treatment more MACE developed in followed period (13 vs. 6). Our results show that optic aggregometry seems to be a usefull laboratory method for antiaggregation drugs effectivity assessment. Prasugrel treatment seems to be more effective than clopidogrel administration in patients with acute STEMI and dPCI of culprit lession.