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European Heart Journal Advance Access published online on October 16, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl317
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received March 7, 2006
Revised September 18, 2006
Accepted September 28, 2006

Clinical research

Effect of clopidogrel on 1-year mortality in hospital survivors of acute ST-segment elevation myocardial infarction in clinical practice

Uwe Zeymer 1 *, Anselm K. Gitt 1, Claus Jünger 1, Tobias Heer 1, Harm Wienbergen 1, Oliver Koeth 1, Timm Bauer 1, Bernd Mark 1, Ralf Zahn 2, Martin Gottwik 2, and Jochen Senges 1, for the Acute COronary Syndromes (ACOS) registry investigators

1 Herzzentrum Ludwigshafen, Department of Cardiology, Medizinische Klinik B, Bremserstrasse 79, D-67063 Ludwigshafen, Germany
2 Klinikum Nürnberg-Süd, Medizinische Klinik 8, Nürnberg, Germany

* To whom correspondence should be addressed.
Uwe Zeymer, E-mail: Uwe.Zeymer{at}t-online.de


  Abstract

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.

Keywords: Clopidogrel; Reperfusion therapy; Primary percutaneous coronary intervention; ST-elevation myocardial infarction; Prognosis.
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