Periprocedural myocardial injury remains a recognized complication of percutaneous coronary intervention (PCI), and the optimal strategy for clopidogrel pretreatment before conventional coronary angiography continues to be debated. In a multicenter study presented at the EuroPCR 2026, investigators evaluated whether different clopidogrel pretreatment approaches influenced rates of periprocedural myonecrosis in patients with angina undergoing PCI.
Clopidogrel-naïve patients received a 600 mg loading dose at least 2 to 24 hours before PCI. Patients already receiving chronic clopidogrel therapy (75 mg daily for at least 5 days) were randomized to receive either an additional 300 mg reload or no additional loading dose.
Findings
- A total of 231 clopidogrel-naïve patients were assigned to the acute loading group.
- Among chronic clopidogrel users, 83 patients received additional reloading and 81 continued chronic therapy without reloading.
- Periprocedural myonecrosis occurred more frequently in the acute loading group compared with the reload and chronic use groups (29 vs 4 vs 1 events; p=0.016).
- Mean CK-MB levels at 24 hours after PCI were significantly higher in the loading group compared with the chronic use group (p=0.022).
- No significant difference in periprocedural myonecrosis was observed between the reload and chronic use groups.
- Troponin I levels at 8 hours after PCI were similar between the loading and chronic therapy groups (p=0.177).
- Platelet reactivity unit (PRU) values also did not differ significantly between groups (p=0.949).
The findings suggest that acute 600 mg clopidogrel loading before PCI was associated with higher rates of periprocedural myonecrosis compared with chronic clopidogrel therapy in patients with angina. Additional clopidogrel reloading among chronic users did not significantly alter outcomes.
