Abstract 3290: Impact of Acute Treatment with Clopidogrel on Inhospital Events in Patients with Acute ST Elevation Myocardial Infarction treated with and without reperfusion therapy. Results of the ACOS-Registry.
Background - In recent randomized clinical trials clopidogrel given in addition to aspirin has been shown to reduce ischemic complications in patients with acute ST elevation myocardial infarction (STEMI) treated with and without reperfusion therapy. Little is known about the safety and efficacy in unselected patients with STEMI in clinical practice.
Methods - In a retrospective analysis of the prospective ACOS registry we compared the outcome of patients with STEMI without reperfusion therapy, with fibrinolysis or primary PCI and treated with aspirin alone or the combination of aspirin and clopidogrel.
Results - A total of 7560 patients with STEMI < 24 hours were included in this analysis, 2141 without reperfusion therapy, 2186 with fibrinolysis and 3232 with primary PCI. The rate of inhospital MACCE (death, reinfarction, stroke) was reduced with clopidogrel in all three reperfusion strategy groups in the multivariate analysis adjusted for age, gender, cardiogenic shock, diabetes, renal insufficiency and adjunctive therapy with beta-blockers, ACE-inhibitors and statins. Bleeding complications were observed in 7.1% versus 3.4% (p=0.001) with aspirin versus aspirin plus clopidogrel.
Conclusions - In clinical practice in unselected patients with STEMI clopidogrel in addition to aspirin significantly reduces inhospital MACCE regardless of the initial reperfusion strategy, but is associated with an increase in bleeding complications.