Acute myocardial infarction

Title: Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomized placebo-controlled trial Summary Background Despite improvements in the emergency treatment of myocardial infarction (MI), early mortality and morbidity remain high. The antiplatelet agent clopidogrel adds to the benefit of aspirin in acute coronary syndromes without ST-segment elevation, but its effects in patients with ST-elevation MI were unclear. Methods 45 852 patients admitted to 1250 hospitals within 24 h of suspected acute MI onset were randomly allocated clopidogrel 75 mg daily (n=22 961) or a matching placebo (n=22 891) in addition to aspirin 162 mg daily. 93% had ST-segment elevation or bundle branch block, and 7% had STsegment depression. Treatment was to continue until discharge or up to 4 weeks in the hospital (mean 15 days in survivors) and 93% of patients completed it. The two prespecified co-primary outcomes were: (1) the composite of death, reinfarction, or stroke; and (2) death from any cause during the scheduled treatment period. Comparisons were by intention to treat and used the log-rank method. This trial is registered with ClinicalTrials.gov, number NCT00222573. Findings Allocation to clopidogrel produced a highly significant 9% (95% CI 3-14) proportional reduction in death, reinfarction, or stroke (2121