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Adding Clopidogrel to Aspirin Therapy Reduces Risk of Death and Complications After Major Heart Attacks: Presented at ACC

By Ed Susman

ORLANDO, FL -- March 9, 2005 -- Results of a study involving more than 45,000 heart attack patients in China showed that adding clopidogrel to their treatment regimen reduced mortality significantly in an in-hospital setting.

Zheng Ming Chen, MD, PhD, associate professor of medicine, University of Oxford, Oxford, United Kingdom, presented the findings here March 9^th at the American College of Cardiology 54^th Scientific Sessions 2005.

In the study -- part of an ongoing Oxford collaboration with scientists in China -- patients presenting with a suspected acute myocardial infarction (MI) characterized by ST-segment changes on an electrocardiogram were treated with either 75 mg of clopidogrel daily plus 162 mg of aspirin or to placebo plus aspirin for 28 days.

The trialists enrolled 22,958 patients who were randomized to clopidogrel treatment and 22,891 patients who were randomized to placebo.

There were 1846 in-hospital deaths in the placebo arm compared to 1728 death in the clopidogrel arm, Dr. Chen reported in a late breaker oral presentation. "That represents a 7% decrease in the relative risk of death for patients taking clopidogrel [P =.03]," Dr. Chen said.

The treatment with clopidogrel also reduced significantly the relative risk of the composite endpoint of death, a second MI or stroke, Dr. Chen said. There were 2311 such events in patients on placebo versus 2125 events in patients on clopidogrel, a 9% reduction (P =.002).

To put the results into perspective, Dr. Chen said, the 1992 landmark Second International Study of Infarct Survival (ISIS-2) study showed that aspirin reduced by 40% cardiovascular events following a major MI. And the results of Clopidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT) showed a risk reduction of 1% above the ISIS-2 results.

"Combined, clopidogrel and aspirin will save 50 people in 1000 from death, a second myocardial infarction or a stroke," he said.

As the discussant of the study at the conference, Christopher Cannon, MD, associate professor of medicine at Harvard Medical School, Boston, Massachusetts, United States, said the success with clopidogrel is noteworthy because more than a dozen other strategies and medications have failed to show any improvement in treating patients with ST-segment elevation MI.

"This study and others presented at this meeting indicate that clopidogrel is a new addition to the treatment of these heart attacks," he said. "Clopidogrel shows benefits in morbidity and mortality, does not appear to cause any additional bleeding concerns, and can be accomplished at low cost."


[Presentation Title: COMMIT/CCS-2: Randomized, Placebo-Controlled Trial of Adding Clopidogrel to Aspirin in 46,000 Acute Myocardial Infarction Patients. Abstract 415-5]

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