title: Clopidogrel in addition to aspirin reduces one-year major adverse cardiac and cerebrovascular events in unselected patients with non-ST segment elevation myocardial infarction.
abstract: 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.
authors.affiliation: Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany. uwe.zeymer@t-online.de
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Anselm K
authors.initials: AK
authors.lastname: Gitt
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Claus
authors.initials: C
authors.lastname: Jünger
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.forename: Oliver
authors.initials: O
authors.lastname: Köth
authors.forename: Tobias
authors.initials: T
authors.lastname: Heer
authors.forename: Harm
authors.initials: H
authors.lastname: Wienbergen
authors.forename: Martin
authors.initials: M
authors.lastname: Gottwik
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: 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
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin