P3-26 RETRIEVAL OF DISLODGED CORONARY INTRAVASCULAR ULTRASOUND CATHETER WITH EMBOLIC PROTECTION DEVICE

Purpose of Introduction/Background: Clopidogrel 300mg loading dose has been shown to benefit patients who undergo percutaneous coronary intervention. However, these trials were limited in heterogeneous procedures, including stenting and balloon angioplasty, and not the real world. This study aimed to compare the outcome benefits among all regimens in stent-implanted patients who had stable coronary artery disease or acute coronary syndrome. Methods: 606 consecutive eligible patients who underwent coronary stenting with dual aspirin and clopidogrel therapy during 2002-2006 were recruited and divided into two groups (pretreatment and post-treatment, respectively) in this study. All data were retrospectively collected by chart review. Composite endpoints included cardiovascular death, nonfatal myocardial infarction, target vessel revascularization, stroke, and unstable angina, were compared by Cox proportional hazard regression model during one year follow up. Results: The cardiovascular event rates during 1-year follow up tended to be higher in post-treatment group, especially in the ST elevation myocardial infarction population (HR 2.91, 95% CI 0.59-14.41, p=0.191) despite no statistical significance. The only independent predictor for composite endpoints in 30 days was clopidogrel duration after stenting (HR 0.89, 95% CI 0.82–0.97, p=0.0006) either in bare metal stenting or drug eluting stenting patients. During 1-year follow up, the clinical determinant that was independently associated with any cardiovascular events included Killip IV in myocardial infarction patients (HR 17.83, 95% CI 5.05-62.86, p<0.001). Conclusions: Clopidogrel pretreatment provided marginal benefit in patients undergoing percutaneous coronary stenting in the real world. All stent-implanted patients should complete 1-month treatment of clopidogrel.