Antiplatelet Therapy Is Effective in Primary Prevention of Myocardial Infarction in Patients With a Previous Cerebrovascular Ischemic Event

OBJECTIVE: A secondary subgroup analysis of the European Stroke Prevention Study of the effect of antiplatelet medication on the risk of myocardial infarction. DESIGN AND SETTING: A randomized, double-blind placebo-controlled study with two parallel treatment groups (dipyridamole plus aspirin and placebo). Sixteen centers from six countries participated in the study. PATIENTS: A total of 2500 patients who had had one or more transient ischemic attacks or cerebral infarctions participated. INTERVENTION: Combination therapy with dipyridamole (75 mg three times a day) and aspirin (330 mg three times a day) was compared with placebo during 24 months' follow-up. OUTCOME MEASURES: Prevention of fatal and nonfatal myocardial infarction. RESULTS: A total of 105 myocardial infarctions occurred in the intention-to-treat analysis and 76 occurred in the explanatory analysis. The overall risk reduction of myocardial infarction with the study drugs was approximately 40% in both statistical analyses, but the result was statistically significant only in the intention-to-treat analysis. Therapeutic efficacy was better among male patients, patients younger than 65 years, and patients with hypertension. CONCLUSION: Combination therapy with dipyridamole and aspirin reduces not only the risk of cerebrovascular ischemic events but also the risk of myocardial infarction.