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Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease through percutaneous cardiovascular interventions.
Improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
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Prof. Petr Widimsky,
Clopidogrel pre-treatment before planned PCI was proved to reduce periprocedural complications. However, majority of patients do not undergo planned PCI, but rather "ad-hoc“ PCI performed a few minutes after coronary angiography. Whether clopidogrel should be administered as pre-treatment to all pts undergoing elective coronary angiography with the aim of ensuring therapeutic levels at the time of possible ad-hoc PCI is not known. View the slides 1028 patients undergoing elective coronary angiography were randomized to group A (“nonselective” - clopidogrel 600 mg > 6 hours before CAG; n = 513) or group B (“selective” - clopidogrel 600 mg in the cath-lab after CAG, only to patients undergoing subsequent PCI; n = 515). The combined primary end-point was death / periprocedural myocardial infarction / stroke or transient ischemic attack / re-intervention within 7 days. Secondary end-points were troponin elevation and bleeding complications. The primary end-point occurred in 0.8% in both groups (non significant, NS). Bleeding complications occurred in 3.5% of group A patients vs. 1.2% in group B (p = 0.02). Periprocedural troponin elevation (> 3x ULN) was detected in 2.7% in group A vs. 3.0% in group B (NS). When only the patients who underwent PCI were analyzed, primary end-point occurred in 1.3% in group A vs. 2.2% in group B (NS). Periprocedural troponin elevation was detected in 8.6% (group A) vs. 11.1% (group B, NS). Bleeding complications occurred in 7.2% (group A) vs. 0.7% (group B, p = 0.006).
Routine clopidogrel pretreatment before elective coronary angiography is not justified – it increases the risk of bleeding complications, while the benefit on periprocedural infarction is not significant. Clopidogrel should be given only to patients with known coronary angiography who undergo PCI and this can be done safely in the catheterization laboratory between the two procedures.
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