Triple antiplatelet therapy before PCI not better than dual therapy

ELISA-2: Trial added GPIIb/IIIa to treatment with aspirin and clopidogrel.

Although a trend toward improvement was noted, there were no significant advantages in reducing enzymatic infarct size by adding a GPIIb/IIIa inhibitor to treatment with aspirin and clopidogrel in patients with non-ST segment elevation acute coronary syndrome who were undergoing elective PCI.

Saman Rasoul, MD, at Isala Klinieken in Zwolle, the Netherlands, presented the results of the ELISA-2 trial at the European Society of Cardiology Congress 2005 in Stockholm.

ELISA-2 enrolled 328 patients who had ischemic chest pain at rest within the previous 24 hours, and either an abnormal ECG, elevated troponin T (>0.05 ng/ml) or elevated creatine kinase–MB levels.

All patients were taking low molecular weight heparin, beta-blockers and statins at enrollment.

Prior to revascularization, patients were randomized to either dual antiplatelet therapy with aspirin plus 600 mg of clopidogrel (Plavix, Bristol-Myers Squibb), or to triple antiplatelet therapy with aspirin, 300 mg clopidogrel and tirofiban (Aggrastat, Merck) at 10 mg/kg bolus followed by a maintenance infusion of 0.15 mg/kg/min.

Enzymatic infarct size

Researchers assessed a primary outcome of enzymatic infarct size and found no difference between the two groups either by measuring peak CK or enzymatic infarct size (LDHQ₄₈).

Initial TIMI 3 flow of the culprit lesion was significantly more often present in patients who received the triple antiplatelet therapy (67% vs. 47%, P=.002).

Patients in the triple-therapy group had a 46% rate of events compared to 57% in the dual-therapy group (P=.098).

Rate of 30-day event-free survival was improved with triple therapy in those ≤65 years old, men and those with ST depression.

Rasoul said further studies would need to be performed to determine if this subgroup effect was real or based on chance.

For more information:

• Rasoul S. ELISA-2: a randomized comparison of double versus triple antiplatelet therapy in patients with non-ST segment elevation acute coronary syndromes. Presented at a Hot Line session of the European Society of Cardiology Congress 2005. Sept. 3-7, 2005. Stockholm.