Emergency clopidogrel could save thousands of lives46,000-patient heart attack trial results

ks and cardiac arrest.

Dr Zhengming Chen of the CTSU, the study's principal investigator, told the ACC's 54th Annual Scientific Session in Orlando, Florida, that adding 75 mg of oral clopidogrel daily to aspirin significantly reduced the relative risk of death in hospital by 7% and the risk of death, repeat heart attack or stroke by about 10%, without any significant increase in serious bleeds. These benefits were additional to those of standard heart attack treatments, and were seen even in older patients and those presenting several hours after the onset of symptoms (who do not typically receive "clot busting" fibrinolytic therapy for their heart attack).

He said: "This means that, on average, adding clopidogrel to current therapies benefits one out of every 100 patients. So, for every million patients having a heart attack, giving this simple additional treatment for about two weeks would save 5,000 lives and prevent another 5,000 repeat heart attacks or strokes. As there are an estimated 10 million heart attacks in the world every year, the findings from this study if implemented appropriately widely would make an important contribution to saving lives and reducing disability."

Professor Rory Collins, co-chair of the study's steering committee and co-director of the CTSU, told the conference that giving three intravenous doses of 5 mg metoprolol during a heart attack, followed by 200 mg daily oral doses in hospital, reduced the relative risk of repeat heart attacks and ventricular fibrillation by 1520%, but increased the relative risk of cardiac shock by about 30% (chiefly during the first day or so of treatment). In absolute terms, the overall balance of these different effects was about even, and there was no clear reduction in hospital mortality for any particular type of patient.

He emphasised that there was already compelling evidence that long-term use of beta-blockers after a heart attack benefited patients. "

Contact: Margaret Willson
MW Communications

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