Key result
Patients with NSTEACS discharged on clopidogrel and aspirin had similar rates of cardiovascular death (9.5% vs 8.3%; p=NS) over 21 months compared to STEMI patients discharged on aspirin alone.
Why the study?
Does combined clopidogrel and aspirin in NSTEACS patients result in different long-term clinical and bleeding outcomes compared to aspirin alone in STEMI patients?
Observational (n=224)
No
Does combined clopidogrel and aspirin in NSTEACS patients result in different long-term clinical and bleeding outcomes compared to aspirin alone in STEMI patients?
Absolute Event Rate: 9.5% vs 8.3%
p-value: p=NS
Hospital survivors of NSTEACS discharged on dual antiplatelet therapy have similar long-term cardiovascular and bleeding outcomes compared to STEMI survivors discharged on aspirin alone.
Similar CV mortality does not support altering DAPT in NSTEACS; hypothesis-generating and requires RCTs versus aspirin alone.
OBJECTIVE: To examine the 21 month clinical outcome and bleeding complications in hospital survivors with non-ST segment elevation acute coronary syndromes (NSTEACS) who were discharged with combined clopidogrel and aspirin anti-thrombotic therapy, and compare with those having ST segment elevation myocardial infarction (STEMI) who were discharged with aspirin alone. DESIGN: Observational study. SETTING: A large university hospital. PATIENTS: 224 patients were admitted to hospital with either NSTEACS or STEMI, and survived to discharge between 1 October 2001 and 31 December 2002. MAIN OUTCOME MEASURES: Cardiovascular death, total death, new myocardial infarction, unstable angina requiring hospitalisation, stroke or transient ischaemic attack, coronary revascularisation; and fatal, life threatening, major and minor bleeding over 21 months after discharge. RESULTS: Despite having no or small infarct (median maximum creatine kinase 155 v 1295 u/l; p<0.001) and taking more antianginal drugs, patients with NSTEACS had similar rates of cardiovascular death (9.5% v 8.3%; p = NS), new myocardial infarction (9.5% v 6.5%; p = NS) or unstable angina requiring hospitalisation (15.5% v 10.2%; p = NS) when compared with STEMI. Fatal, life threatening or major bleeding were <1% in both groups (p = NS); and minor bleeding occurred in 4.3% NSTEACS and 2.8% STEMI patients respectively (p = NS). CONCLUSIONS: Patients with NSTEACS had a similar and unfavourable long term outcome when compared with STEMI. There was no difference in serious bleeding complications between both groups.
No takes yet. Share an insight, caveat, or question.
Wong et al. (2006) conducted an observational in Acute coronary syndromes (n=224). NSTEACS discharged with combined clopidogrel and aspirin vs. STEMI discharged with aspirin alone was evaluated on Cardiovascular death (p=NS). Patients with NSTEACS discharged on clopidogrel and aspirin had similar rates of cardiovascular death (9.5% vs 8.3%; p=NS) over 21 months compared to STEMI patients discharged on aspirin alone.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: