April 11, 2006European Heart Journal
Effect of clopidogrel on 1-year mortality in hospital survivors of acute ST-segment elevation myocardial infarction in clinical practice
Key result
Adjunctive therapy with clopidogrel plus aspirin in STEMI survivors was associated with significantly lower 1-year mortality compared to aspirin alone (OR 0.48; 95% CI 0.48-0.61).
Why the study?
Does clopidogrel added to aspirin reduce 1-year mortality in hospital survivors of acute STEMI?
Population
5,886 consecutive hospital survivors of acute ST-segment elevation myocardial infarction prospectively…
Comparison
Clopidogrel plus aspirin at discharge vs Aspirin alone at discharge
Design
Cohort
Follow-up
12+2 months
Authors
Discussion
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Implication
May support dual antiplatelet therapy at STEMI discharge; leaves open confirmation in randomized trials.
Key Points
- To evaluate the association between adjunctive clopidogrel therapy at hospital discharge and 1-year mortality among survivors of acute ST-segment elevation myocardial infarction in real-world clinical practice.
- Analyzed 5,886 consecutive STEMI survivors enrolled in the prospective Acute Coronary Syndromes (ACOS) registry between July 2000 and November 2002, comparing discharge regimens of aspirin plus clopidogrel (n=3,795) versus aspirin alone (n=2,091).
- Stratified patients by initial reperfusion modality: no reperfusion therapy (n=1,445), fibrinolysis (n=1,734), or primary percutaneous coronary intervention (PCI; n=2,707).
- Conducted multivariable propensity score-adjusted analyses for 12±2 month post-discharge mortality adjusting for demographics, clinical presentation, and concurrent medical therapies.
- Adjunctive clopidogrel combined with aspirin was associated with a significant reduction in 1-year mortality across the overall cohort compared to aspirin alone (OR 0.48, 95% CI 0.48–0.61).
- Survival benefits were marked in patients receiving reperfusion therapy, specifically primary PCI (OR 0.38, 95% CI 0.23–0.62) and fibrinolysis (OR 0.53, 95% CI 0.32–0.87).
- Mortality reduction was not statistically significant in patients who did not receive reperfusion therapy (OR 0.96, 95% CI 0.65–1.45).
Study Design
Type
Cohort (n=5,886)
Structured PICO
Does clopidogrel added to aspirin reduce 1-year mortality in hospital survivors of acute STEMI?
P
Population
5,886 consecutive survivors of acute STEMI discharged with either aspirin alone or aspirin plus clopidogrel, followed for 12+2 months.
E
Exposure
Clopidogrel plus aspirin at discharge
C
Comparator
Aspirin alone at discharge
O
Outcome
12+2 month mortality after dischargehard clinical
Main Result
Odds Ratio: 0.48 (95% CI 0.48–0.61)
In clinical practice, adding clopidogrel to aspirin at discharge for STEMI survivors is associated with a significant reduction in 1-year mortality, particularly in those receiving early reperfusion therapy.
Cite This Study
Zeymer et al. (2006) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=5,886). Aspirin plus clopidogrel vs. Aspirin alone was evaluated on 12+2 month mortality after discharge (OR 0.48, 95% CI 0.48-0.61). Adjunctive therapy with clopidogrel plus aspirin in STEMI survivors was associated with significantly lower 1-year mortality compared to aspirin alone (OR 0.48; 95% CI 0.48-0.61).