Effect of operator and institutional volume on clinical outcomes after percutaneous coronary interventions performed in Canada and the United States: a brief report from the Enhanced Suppression of the Platelet glycoprotein IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) study.

Background: The Enhanced Suppression of the Platelet glycoprotein IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial compared the use of eptifibatide with placebo in 2064 coronary intervention patients. It was previously reported that Canadian patients had reduced rates of 30-day and one-year death, myocardial infarction (MI) or target vessel revascularization (TVR) compared with patients in the United States (US).

Objective: To examine whether operator or institutional volume differences explain the regional variation in clinical outcome.

Clopidogrel in interventional cardiology: questions answered and questions remaining.

Clopidogrel is appropriate as a replacement for ticlopidine when used in combination with acetylsalicylic acid in the setting of percutaneous coronary intervention (PCI). Compared with ticlopidine, clopidogrel has comparable efficacy in reducing adverse cardiac events and a lower risk of hematological toxicity; both medications have been associated with rare cases of the very serious syndrome of thrombotic thrombocytopenic purpura. Clopidogrel should preferably be initiated with a loading dose of 300 mg before PCI, because most cases of thrombotic stent occlusion occur shortly after stent implantation, and attainment of target platelet inhibition is delayed for several days if a loading dose is not given.