March 10, 2005New England Journal of Medicine
Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation
Why the study?
Does the addition of clopidogrel to aspirin and fibrinolytic therapy reduce the composite of an occluded infarct-related artery, death, or recurrent myocardial infarction in patients 18 to 75 years of age with ST-elevation myocardial infarction?
Population
n=3491 patients, 18 to 75 years of age, who presented within 12 hours after the onset of an ST-elevation…
Comparison
Clopidogrel added to a fibrinolytic agent… vs Placebo added to a fibrinolytic agent, aspirin…
Design
RCT, randomly assigned
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Supports adding clopidogrel to aspirin and fibrinolysis in STEMI ≤75 years; extends dual antiplatelet evidence to fibrinolytic-treated patients.
Structured PICO
Does the addition of clopidogrel to aspirin and fibrinolytic therapy reduce the composite of an occluded infarct-related artery, death, or recurrent myocardial infarction in patients 18 to 75 years of age with ST-elevation myocardial infarction?
P
Population
n=3491 patients, 18 to 75 years of age, who presented within 12 hours after the onset of an ST-elevation myocardial infarction.
I
Intervention
Clopidogrel (300-mg loading dose, followed by 75 mg once daily) added to a fibrinolytic agent, aspirin, and when appropriate, heparin (dispensed according to body weight).
C
Comparator
Placebo added to a fibrinolytic agent, aspirin, and when appropriate, heparin (dispensed according to body weight).
O
Outcome
Composite of an occluded infarct-related artery (defined by a Thrombolysis in Myocardial Infarction flow grade of 0 or 1) on angiography or death or recurrent myocardial infarction before angiography (scheduled 48 to 192 hours after the start of study medication).composite
In patients 75 years of age or younger with STEMI receiving standard fibrinolytic therapy, the addition of clopidogrel significantly improves infarct-related artery patency and reduces ischemic complications without increasing major bleeding.
Cite This Study
Sabatine et al. (2005) studied this question.