European Heart Journal Advance Access originally published online on October 16, 2006
European Heart Journal 2006 27(22):2661-2666; doi:10.1093/eurheartj/ehl317
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Effect of clopidogrel on 1-year mortality in hospital survivors of acute ST-segment elevation myocardial infarction in clinical practice
1 Herzzentrum Ludwigshafen, Department of Cardiology, Medizinische Klinik B, Bremserstrasse 79, D-67063 Ludwigshafen, Germany
2 Klinikum Nürnberg-Süd, Medizinische Klinik 8, Nürnberg, Germany
Received 7 March 2006; revised 18 September 2006; accepted 28 September 2006; online publish-ahead-of-print 16 October 2006.
* Corresponding author. Tel: +49 621 503 4045; fax: +49 621 503 4002. E-mail address: Uwe.Zeymer{at}t-online.de
Aims 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.
Methods and results 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].
Conclusion 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.
Key Words: Clopidogrel • Reperfusion therapy • Primary percutaneous coronary intervention • ST-elevation myocardial infarction • Prognosis
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. H. Lin, N. R. Barshes, S. Annambhotla, and T. T. Huynh Prospective Randomized Trials of Carotid Artery Stenting Versus Carotid Endarterectomy: An Appraisal of the Current Literature Vascular and Endovascular Surgery, March 1, 2008; 42(1): 5 - 11. [Abstract] [PDF]
|
|
|
|
 |
|
 A. K. Gitt and A. Betriu Antiplatelet therapy in acute coronary syndromes Eur. Heart J. Suppl., January 1, 2008; 10(suppl_A): A4 - A12. [Abstract] [Full Text] [PDF]
|
|