Summary

Elevated troponin after elective percutaneous coronary intervention(PCI) has been associated with a worse prognosis. Pretreatmentwith clopidogrel may be beneficial in patients undergoingPCI. Therefore, a prospective observational study wasconducted to address the potential role of clopidogrel in reducingtroponin release after elective PCI.TroponinT was measured12 hours after elective PCI in 656 patients without elevated troponinbefore PCI. To assess the independent association betweenpre-treatment with clopidogrel and increased troponin,multivariate analyses were performed. Mean age of the 656 patientswas 63.5 years (SD 10.2), 194 patients (30%) were femaleand 114 patients (17.4%) had diabetes.In 217 patients (33%) troponinwas increased after PCI. Of the 330 patients who werenot pre-treated with clopidogrel, 118 patients (34%) had increasedtroponin after the PCI compared to 99 patients (30%) of the 326 patients who were treated with clopidogrel longerthan 24 hours before the procedure (p=0.14). Stratified analysesshowed that patients with older age (p=0.03), previous PCI(p=0.013), angina CCS 4 (p=0.03) and multivessel disease(p=0.04) had a significantly lower risk of troponin increase afterpre-treatment with clopidogrel compared to patients withoutpre-treatment.After adjusting for differences in the other variables,patients who were pre-treated with clopidogrel had a significantlower risk of post-PCI increase of troponinT (odds ratio0.69, 95% confidence interval 0.49–0.99). Pre-treatment withclopidogrel is associated with a significantly lower incidence ofincreased troponin after elective PCI. Combined with results ofother studies, pre-treatment should be advised in patients waitingfor elective PCI.