Personalized antiplatelet treatment after percutaneous coronary intervention: The MADONNA study

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• 作者：Jolanta M. Siller-Matula ; Marcel Francesconi ; Cornelia Dechant ; Bernd Jilma ; Gerald Maurer ; Georg Delle-Karth ; Ghazaleh Gouya ; Katharina Ruzicka ; Andrea Podczeck-Schweighofer ; G¨¹nter Christ
• 关键词：Platelets ; Stent thrombosis ; Clopidogrel ; Acute coronary syndrome ; Personalized treatment
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：1 September, 2013
• 年：2013
• 卷：167
• 期：5
• 页码：2018-2023
• 全文大小：457 K

文摘

Background and objectives

Clopidogrel non-responsiveness is associated with adverse clinical outcome. We aimed to investigate whether individualized antiplatelet treatment in clopidogrel non-responders is an effective and safe strategy.

Methods

This was a prospective non-randomized non-blinded study comparing two cohorts (guided and non-guided treatment) with a follow-up of 1-month. Responsiveness to clopidogrel was assessed by multiple electrode aggregometry (MEA) in 798 patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). In the guided group (n = 403) clopidogrel non-responders received repeated loading doses of clopidogrel or prasugrel, in the non-guided group (n = 395) clopidogrel non-responders did not undergo any change in treatment.

Results

Stent thrombosis occurred significantly less often in the guided group than in the non-guided group (0.2 % vs. 1.9 % ; p = 0.027). The multivariate Cox regression analysis showed that patients in the non-guided group were at a 7.9-fold higher risk to develop stent thrombosis compared to the guided group (OR: 7.9; 95 % CI: 1.08-69.2; p = 0.048). In line with this, acute coronary syndrome occurred significantly less often in the guided group than in the non-guided group (0 % vs. 2.5 % ; p = 0.001) whereas there was no difference in the event rates of cardiac death (2 % vs. 1.3 % ; p = 0.422) or major bleedings (1 % vs. 0.3 % ; p = 0.186).

Conclusion

Personalized antiplatelet treatment according to the platelet function testing with MEA resulted in an improved efficacy with an equal safety compared to the standard treatment.