Effect of clopidogrel on 1-year mortality in hospital survivors of acute ST-segment elevation myocardial infarction in clinical practice

• Published in: European heart journal Vol. 27; no. 22; pp. 2661 - 2666
• Main Authors: ZEYMER, Uwe, GITT, Anselm K, SENGES, Jochen, JÜNGER, Claus, HEER, Tobias, WIENBERGEN, Harm, KOETH, Oliver, BAUER, Timm, MARK, Bernd, ZAHN, Ralf, GOTTWIK, Martin
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-11-2006; Oxford Publishing Limited (England)
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Diseases of the cardiovascular system; Female; Heart; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocarditis. Cardiomyopathies; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Myocardial infarction; ST-elevation myocardial infarction; Prognosis; Angioplasty; Primary percutaneous coronary intervention; Cardiovascular disease; Myocardial disease; Epidemiology; Phlebology; Stent; ST elevation; Reperfusion; Primary; Hospital; Cardiology; Public health; Survivor; Acute; Mortality; Coronary artery; Instrumentation therapy; Hospitalization; Coronary heart disease; Reperfusion therapy; Professional practice; Clopidogrel; Circulatory system
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehl317

We sought to assess the effect of clopidogrel on clinical events 1 year after discharge in survivors of ST-elevation myocardial infarction (STEMI) in clinical practice.
We analysed data of consecutive survivors of acute STEMI and either concomitant therapy with aspirin or aspirin plus clopidogrel at discharge, who were prospectively enrolled in the Acute Coronary Syndromes (ACOS) registry between July 2000 and November 2002. A total of 5886 (3795 with and 2091 without clopidogrel) patients were included into this analysis. Patients were divided into three groups according to the initial reperfusion therapy: no reperfusion therapy (n=1445), fibrinolysis (n=1734), or primary PCI (n=2707). The multivariable analysis for 12+2 month mortality after discharge using the propenstiy score with adjustment for baseline characteristics and treatments (age, sex, diabetes mellitus, hypertension, prior MI, hyperlipidaemia, renal insufficiency, cardiogenic shock, heart rate, systolic blood pressure, anterior infarct location, reduced left ventricular function, elective revascularization, beta-blockers, statins, ACE-inhibitors) showed that mortality was significantly lower in the aspirin plus clopidogrel group compared with the aspirin group in the total group and patients with reperfusion therapy [total group odds ratio (OR) 0.48, 95% confidence interval (CI) 0.48-0.61; no reperfusion therapy OR 0.96, 95% CI 0.65-1.45; fibrinolysis OR 0.53, 95% CI 0.32-0.87; primary percutaneous coronary intervention OR 0.38, 95% CI 0.23-0.62].
In clinical practice, adjunctive therapy with clopidogrel, in addition to aspirin, in survivors after STEMI is associated with a reduction in 1-year mortality in patients treated with early reperfusion therapy.