The effects of clopidogrel pretreatment on pre and postprocedural inflammatory markers in patients with non st elevated acute coronary syndromes undergoing percutenous coronary intervention

10-) SUMMARYTHE EFFECTS OF CLOP DOGREL PRETREATMENT ON PRE ANDPOSTPROCEDURAL NFLAMMATORY MARKERS N PAT ENTS W TH NONST ELEVATED ACUTE CORONARY SYNDROMES UNDERGO NGPERCUTENOUS CORONARY INTERVENTIONBackground and PurposeThe role of inflammation in chronic atherosclerosis and acute coronary syndrome (ACS)pathophysiology is well known.Clopidogrel is used routinely in acute coronary syndromes and percutenous coronaryinterventions (PCI) because of its potent antiplatelet actions. But it was recently shownthat, this molecule has also some antiinflammatory effects. But so far, there is no plasebocontrolled study about Clopidogrel?s antiinflammatory effects during ACS.In this study, in patients with non ST elevated ACS undergoing PCI, the effects ofClopidogrel pretreatment on preprocedural and postprocedural hsCRP and sCD40L levelswere investigated.Method:A total of 52 patients with non ST elevated ACS were enrolled to the study. Onegroup recieved Clopidogrel immediately after PCI with a loading dose of 600mg. (Group 1,n=23)The other group was given Clopidogrel on admission with a loading dose of 300mg. Thedose was then completed to 600mg till the PCI.(Group 2,n=29) Baseline, preprocedural(just before PCI), and postprocedural (24 hours after PCI) hsCRP and sCD40L levels weremeasured in each group.Results:Baseline hsCRP and sCD40L levels were similiar in each group. In group 2,preprocedural hsCRP level was not different from baseline level, whereas preproceduralsCD40L was significantly lower than baseline. In group 1 neither hsCRP nor sCD40Lchanged significantly before PCI compared with baseline. In both groups there was asignificant increase in inflammatory markers after PCI. But the degree of this increase wassignificantly higher in group 1 compared with group 2. (hs CRP: 4.7 vs 2.5 mg/L, p=0,001sCD40L: 5.3 vs 1.9 ng/mL, p=0,04) The levels of hsCRP and sCD40L in each group areshown in details in table.59Grup-1 Grup-2 P değerihs-CRP baseline* 5,3 7,1 0,82scd40L baseline** 11,9 10,5 0,63hs-CRP preprocedural* 8,1 7,1 0,4scd40L preprocedural** 10,1 8,4 0,06hs CRP postprocedural* 13,3 8,4 0,055scd40L postprocedural** 15,9 11,4 0,006(median values are used)* mg/L **ng/mlConclusion:These results show that, early initiation of Clopidogrel treatment in patients with non STelevated ACS undergoing PCI, results in a decline in inflammatory status bothpreprocedurally and postprocedurally.60