Adding the anti-platelet drug clopidogrel to aspirin for the emergency treatment of heart attacks could save thousands of lives each year, according to a study published in this week's issue of The Lancet. The treatment should be considered routinely for suspected heart attacks, state the authors, as it can safely reduce mortality in hospital for a wide range of patients.

About 10 million people have heart attacks every year worldwide. Although improvements have been made in emergency treatment, the risks of early death and repeat heart attack remains high. Previous studies have shown that clopidogrel adds to the benefit of aspirin in acute coronary syndromes without ST-segment elevation*. However, clopidogrel's effect on major heart attack patients with ST-elevation has been unclear until now.

Zhengming Chen (University of Oxford, UK) and colleagues recruited over 45,800 patients with onset of heart attack from 1250 hospitals in China into the study. The investigators randomly allocated patients to 75 mg clopidogrel daily or placebo, in addition to daily aspirin (as well as other standard treatments) until they were discharged or had spent up to 4 weeks in hospital. 93% of patients had ST-segment elevation and 7% had ST-segment depression. The researchers found that clopidogrel reduced deaths, repeat heart attacks, and stroke by 9% when compared with placebo, and led to a 7% reduction in deaths alone. They also found that patients allocated clopidogrel had a 14% reduction in repeat heart attacks during the scheduled treatment period. The results also show that the treatment is safe, with no apparent increase in life-threatening bleeding.

Dr Chen concludes: "If early clopidogrel therapy was given in hospital to just 1 million of the 10 million patients who have a heart attack every year then it would, on present evidence, prevent about 5000 deaths and 5000 non-fatal reinfarctions and strokes. Moreover, continued treatment with clopidogrel af
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
3-Nov-2005

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