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Right Ventricular Dysfunction in Myocardial Infarction: A New Risk Factor for Clopidogrel Resistance?

Silvio Quick, Marian Christoph, Stefanie Schmeinck, Kristin Schmieder, C.Pfluecke, Uwe Speiser, Carsten Wunderlich, Ruth H Strasser, Steffen Kolschmann and Karim Ibrahim

Aims: Mortality in acute coronary syndroms (ACS) complicated by right ventricular dysfunction (RVD) still remains high. The aim of this study was to determine the association between RVD in ACS and the platelet inhibitory effect of clopidogrel.

Methods: In this single center observational study 50 patients with ACS were investigated, 38 with normal right ventricular function and 12 with RVD as determined by echocardiography and electrocardiography. The effect of clopidogrel was determined by the PRI/VASP-Index 24 hours after loading dose of 600 mg. PRI/VASP-Indices above 50% were claimed as clopidogrel non-responder.

Results: PRI/VASP-Index was significant higher in the RVD-group compared to control (Median: 74.5% ± 12.3 vs. 26.5% ± 23.3, p<0.01). The percentage of patients with unsatisfactory effect was significantly higher in the RVD group compared to control (83.3% vs. 23.7%, p<0.01). There were no increased rates of adverse cardiac events in both groups.

Conclusions: Patients with RVD complicating myocardial infarction show a significantly impaired response to clopidogrel. These patients suffer from congestive gastro- and enteropathy and liver dysfunction, in consequence resorption and metabolization of orally administered drugs including platelet-inhibitors like clopidogrel might be compromised.