Thromb Haemost 2008; 99(01): 155-160
DOI: 10.1160/TH07-09-0556
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Clopidogrel in addition to aspirin reduces in-hospital major cardiac and cerebrovascular events in unselected patients with acute ST segment elevation myocardial

Uwe Zeymer
1   Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany
2   Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg
,
Anselm K Gitt
1   Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany
2   Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg
,
Claus Jünger
2   Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg
,
Timm Bauer
1   Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany
,
Oliver Koeth
1   Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany
,
Tobias Heer
1   Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany
,
Bernd Mark
1   Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany
,
Ralf Zahn
1   Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany
,
Martin Gottwik
3   Klinikum Nürnberg-Süd, Medizinische Klinik 8, Nürnberg, Germany
,
Jochen Senges
1   Herzzentrum Ludwigshafen, Medizinsche Klinik B, Ludwigshafen, Germany
2   Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg
› Author Affiliations
Financial support: Supported by an unrestricted grant of Sanofi-Aventis AG, Berlin, Germany
Further Information

Publication History

Received: 10 September 2007

Accepted after major revision: 19 October 2007

Publication Date:
24 November 2017 (online)

Summary

We sought to assess the effect of clopidogrel on in-hospital events in unselected patients with acute ST elevation myocardial infarction (STEMI). In a retrospective analysis of consecutive patients enrolled in the Acute Coronary Syndromes (ACOS) registry with acute STEMI we compared outcomes of either adjunctive therapy with aspirin alone or aspirin plus clopidogrel within 24 hours after admission. A total of 7,559 patients were included in this analysis, of whom 3,541 were treated with aspirin alone, and 4,018 with dual antiplatelet therapy. The multivariable analysis with adjustment for baseline characteristics and treatments showed that the rate of in-hospital MACCE (death, non-fatal reinfarction, non-fatal stroke) was significantly lower in the aspirin plus clopidogrel group, compared to the aspirin alone group in the entire cohort and all three reperfusion strategy groups (entire group odds ratio 0.60, 95% CI 0.49–0.72, no reperfusion OR 0.69,95% CI 0.51–0.94,fibrinolysis OR 0.62,95% CI 0.44–0.88, primary PCI OR 0.54, 95% CI 0.39–0.74).There was a significant increase in major bleeding complications with clopidogrel (7.1% vs. 3.4%, p<0.001). In clinical practice early adjunctive therapy with clopidogrel in addition to aspirin in patients with STEMI is associated with a significant reduction of in-hospital MACCE regardless of the initial reperfusion strategy. This advantage was associated with an increase in major bleeding complications.

 
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