Prémédication par thiénopyridines avant angioplastie coronaire dans l’angor instable

Abstract

Ticlopidine or clopidogrel combined with aspirin decrease major cardiac events (Mace) after PTCA with stent implantation. It has not be proven yet that pretreatment by T or C was superior to conventional post-treatment, especially in unstable patients. The aim of the present study was to determine the influence of thienopyridine pretreatment on the risk of Mace (death, Q wave myocardial infarction, need for repeat PTCA or surgery, angina recurrence, stent thrombosis) during the hospitalization period in a population prospectively included in 2 multicentre registries of patients undergoing placement of a S670 ® or S7 ® stent (Medtronic) implanted in native coronary arteries (≥3.0 mm). Among the 2929 patients included into the registries, 1205 had unstable angina (41 %). 50,2% of the patients were pretreated by T or C ( T = 15.7%, C = 34.5%); 85.5% received aspirin before the procedure; definition of pretreatment was the administration of drug at least 6 hours before stent implantation. GPIIb-IIIa antagonists were administered in only 13.9% of patients. Mace were observed in 2% of the patients. Factors correlated with Mace by univariate and multivariate analyses were: age >73 years (RR: 2.37; 95 % CI: 1.05–5.36, P < 0.037) , previous myocardial infarction (RR: 2.56; 95% CI: 1.08–6.11, P <0.034), pretreatment by T or C (RR: 0.389; 95% CI: 0.16-0.95, P < 0.038). In patients who did not receive GPIIb-IIIa antagonists, age >73, and pretreatment by T or C were the only independent predictors of Mace.