The prevention of minor myocardial injury with ticlopidine pretreatment in patients undergoing elective coronary stenting

The aim of the study was to determine whether ticlopidine treatment prior the coronary stenting would be associated with lower rates of procedure-related minor myocardial injury (MMI) in patients undergoing elective coronary stenting. In this retrospective, nonrandomized, uncontrolled study, a total of 153 consecutive patients with a mean age of 63.4+/-8.9 years were divided into two groups based on the duration of ticlopidine treatment: group I (n=81), ticlopidine/=3 days before the procedure, group II (n=72), on the same day as stent placement. Cardiac troponin T (cTnT) was measured immediately before and 12 h after the procedures. All patients were followed-up during the hospital stay with respect to MMI and major clinical events (MCE). The increase frequency and the amount of cTnT level in group I was found to be significantly lower compared with group II (4 vs. 13; P0.01, and 0.35+/-0.06 vs. 0.52+/-0.11 ng/ml; P0.01, respectively). In general, patients with elevated cTnT levels are more likely to have C type lesion and multivessel procedure than those of normal cTnT level (41 vs.10%; P0.002 and 47 vs. 17%; P0.009, respectively). Though there was a trend toward increased MCE rates in group II than that of group I, this did not reached statistical significance (3 vs.1; P=NS). The present study shows that an anti-platelet treatment with ticlopidine prior the coronary stenting of adequate duration to allow for the development of maximal inhibition is associated with a markedly decreased incidence of procedure-related MMI. Therefore, ticlopidine pretreatment may be a cost alternative for the prevention of platelet-rich microembolism in patients undergoing elective coronary stenting.