Clopidogrel in addition to aspirin reduces one-year major adverse cardiac and cerebrovascular events in unselected patients with non-ST segment elevation myocardial infarction.
OBJECTIVE
We sought to assess the effect of clopidogrel on one-year ischemic events in unselected patients with NSTEMI.


METHODS
We analysed data of consecutive patients with acute NSTEMI treated with aspirin or aspirin plus clopidogrel, who were prospectively enrolled in the ACOS registry.


RESULTS
A total of 4290 patients were included, 2171 were treated with aspirin and 2119 with aspirin plus clopidogrel. In the univariate analysis in-hospital (13.7% versus 6.3%, P<0.001) and one-year (28.1% versus 15.6 %, P<0.001) mortality and the combined endpoint of death, non-fatal myocardial infarction and non-fatal stroke was significantly lower in the clopidogrel group. There was a significant increase in in-hospital bleeding complications with clopidogrel (5.4 % versus 3.3 %, P<0.05). In the multivariable propensity score analysis adjusted for baseline variables the odds ratio for the one-year combined endpoint was significantly reduced (odds ratio 0.69, 95% CI: 0.64-0.74) in the aspirin plus clopidogrel group.


CONCLUSIONS
In clinical practice, early therapy with clopidogrel, in addition, to aspirin in patients with NSTEMI is associated with a significant reduction of the combined endpoint of death, non-fatal reinfarction and non-fatal stroke after one year. This advantage was associated with an increase in major in-hospital bleeding complications.
Zeymer
Uwe
U
Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany. uwe.zeymer@t-online.de
Gitt
Anselm K
AK
Zahn
Ralf
R
Jünger
Claus
C
Bauer
Timm
T
Köth
Oliver
O
Heer
Tobias
T
Wienbergen
Harm
H
Gottwik
Martin
M
Senges
Jochen
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D000077144:Clopidogrel; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin