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| Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation |
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| Author(s): Sabatine MS, Cannon CP, Gibson CM, Lopez-Sendon JL, Montalescot G, Theroux P, Claeys MJ, Cools F, Hill KA, Skene AM, McCabe CH, Braunwald E, Braunwald E, Cannon C, Sabatine M, McCabe C, McCagg A, Job B, Gaudin C, Thizon-de Gaulle I, Blumenthal M, Saini R, Delaet I, Townes L, Anhalt D, van Holder K, Skene A, Hill K, Braunwald E, Cannon C, Sabatine M, McCabe C, Job B, Gaudin C, Thizon-de Gaulle I, Blumenthal M, Saini R, Delaet I, Townes L, Skene A, Ardissino D, Aylward P, Bertrand M, Bode C, Budaj A, Claeys M, Dellborg M, Ferreira R, Gershlick A, Huber K, Keltai M, Kleiman N, Lewis B, Lopez-Sendon J, Marx J, Montalescot G, Nicolau J, Ongen Z, Paolasso E, Pons JL, Ruda M, Theroux P, Van de Werf F, Verheugt F, Wilcox R, Zeymer U, Braunwald E, Cannon C, Sabatine M, Gibson M, McCabe C, McCagg A, Job B, Gaudin C, Thizon-de Gaulle I, Blumenthal M, Saini R, Froehlich J, Delaet I, Townes L, Anhalt D, van Holder K, Pieters A, Skene A, Hill K, Charlesworth A, Goulder M, Stead S, Wiviott S, Aroesty J, Berger C, Garcia L, Greer D, Leeman D, Lyle H, Philippides G, Schwamm L, Gibson M, Marble S, Aroesty J, Buros J, Ciaglo L, Kirtane A, Shui A, Wilson A, Scirica B, Morrow D, Giugliano R, Wiviott S, Morrow D, Ridker P, Rifai N, Sabatine M, Kucherlapati R, Kwiatkowski D, Stone P, Maccallum G, Lucier M, Garriga A, Anderson J, Fox K, Kelsey S, Batalla A, Areses ELD, Fiol M, Bethencourt A, Lozano I, Figueras J, Cortes JG, Jimenez AG, Fernandez AR, Montero IF, Casasnovas J, Aso FO, de Blas RC, Audicana J, Errazti IE, Montero JS, Rohlfs I, Pinero C, Rodriguez MM, Alvarez LV, Belras AC, Barros S, Fernandez JD, Tobaruela A, Bonneau A, Soulat L, Lambert Y, Caussanel J, Livareck B, Ramaut C, Ricome J, Lapostolle F, Beruben A, Thieleux F, Martelli J, Martelet M, Mouallem J, Ahmed F, Galley D, Alhabaj S, Doucos D, Bearez E, Spetebroodt S, Gully C, Dujardin J, Averland B, Emmonot B, Pollet D, Vallet P, Mossaz R, Marquand A, Kermarrec A, Le Lay C, Douillet R, Olliver L, Matas O, Kassam S, Halperin F, Parsons P, Bovak B, Hart B, Sussex B, Newman S, Gosselin G, David M, Sidhar K, Wiseman D, Lefkowitz C, Thornley M, Bhargava R, McCullum A, Grandmond D, Carignan D, Kouz S, Roy M, Polasek P, Stedham V, Lai K, Paquette B, Raco D, Sayles M, Sridhar K, Wiseman D, Tremblay B, Darveau C, Sussex B, Newman S, Senaratne M, Holland M, Bata I, Hulan M, Constance C, Pouliot S, Gossard D, Day L, Glanz A, Vilag C, Hui W, Kvill L, Dion D, Morisette A, Sandrin F, Mitges S, Cools F, Vanhagendoren S, De Meester A, Marcovitch O, Allaf E, Gits F, Verrostte J, Thoeng J, Quinonez M, Appeltants H, D'Hooghe G, Eycken M, Swennen I, Hollanders G, Michael E, Decroly P, Rombaut E, Carlaire D, Vermander D, Marenne SF, Gavray C, Michel P, Poth A, Paquay J, Lutasu S, Dirk D, Vermeulen J, Govaerts E, Boldueva S, Sherenkov A, Ruda M, Kostenko V, Tereschenko S, Zalevsky G, Boyarkin M, Tankhilevitch B, Glezer M, Gratsiansky N, Shlyakhto E, Sidorenko B, Zadiontchenko V, Perepech N, Gruzdev A, Chernov S, Pollock B, Andresen D, Hoffmann S, Andresen D, Arntz H, Klein H, Neuss H, Wilhelms E, Henzgen R, Kuckuck H, Darius H, Hausdorf C, Ochs H, Olbrich H, Willenbrock R, Hepp A, Wucherpfennig P, Wiechmann H, Schmidtendorf H, Kohler B, Sehnert W, Ueberreiter A, Uebis R, Stockmann M, Rommele U, Meissner A, Schneider L, Adgey J, McAllister T, McEneaney D, Mackin A, Sulke N, Dixon R, Wilcox R, Congreave S, Flapan A, Flint L, Purvis J, McCorkell G, Stubbs P, Steer C, McKkee P, Senior R, Chester L, Levy T, Kennard S, Bishop A, Hlaing S, de Belder M, Cunningham N, Gilbert T, Young J, Henderson R, Falcon-Lang D, Gershlick A, Fairbrother K, Rosenfeld T, Atar S, Lewis B, Yuval R, Meisel S, Alony I, Rozenman Y, Logrineuko S, Goldhammer E, Harel S, David D, Erez N, Jafari J, Tubul O, Marmor A, Pritulo L, Caspi A, Roitberg N, Kaluski E, Amar R, Tzivoni D, Rojanski A, Yedid-Am S, Keren A, Datiashvily L, Saraiva JK, Garcia CT, Markman M, Chaves A, Vaz RC, Dutra O, Coelho OR, Sciampaglia R, da Cunha CP, de Brito MR, Lotufo P, Ribeiro E, Cicogna A, Michalaros YL, Ornellas CE, Santos SCD, Rosatelli P, Pimentel W, Grudzinski M, Guimaraes F, Gustavo C, Moreira M, Gosmao J, Hertzberger D, Schut A, van der Zwaan C, Havenaar H, van Wijngaarden J, Verheij H, Wajon E, Bosschaart M, Oomen A, Daniels M, Coppes A, Vergeught F, Dieker H, Jochemsen D, Fijlstra I, Leenders C, Gelder T, Janicke D, Bass J, Hamroff G, Keeler K, Chandra M, Van Hoose B, Minor S, Mock P, Chandra M, Olliges M, Unwala A, Fisher C, French W, Barillas O, Chandna H, Holly D, Chandna H, Holly D, Grewal G, Gurnsey L, Mehta P, Cruse A, Perlman R, Palazzo D, Puma J, Payne C, Torres J, Patten L, Lefkovic L, Viswanathan N, Rees A, Yoches A, Rodriguez-Ospina L, Santos J, Chohan A, Kemp A, Perlman R, Palazzo D, Weiss R, Brennan B, Aude Y, Harrison P, Brogan G, Ayan J, Cragg D, Murawka A, Garg M, McKelvy J, Hulyalkar A, Kuchenrither C, Jackson S, Whitaker J, Richardson J, Vicari R, Howard M, Aude Y, Harrison P, Chadow H, Hauptman R, Gelormini J, Giambra T, Lakkis N, Jiang S, Hernandez I, Vazquez A, Rosas EL, Lawrenz JC, Bustamante F, Martinez CA, Alcocer MA, Hernandez EG, Dogre CW, Bustillos MDB, Alvarado R, Ramirez MC, Hinojosa P, Rivera OO, Pons JL, Carrillo J, Velasco JA, Quintana F, Petersen F, Palomera R, Ibarra M, Sanchez CJ, Delgado L, Bayram E, Machado GM, Berli MA, Vinuela JC, Allall O, Fuentealba V, Reguero M, Covelli G, San Martin E, Francia E, Gadaleta F, Haehnel M, Iglesias R, Blumberg S, de Lima AA, Henquin R, Estrada JN, de Arenaza D, Fernandez R, Abud M, Becker C, Milesi R, Schamuck R, Doyharzabal JM, Caime DG, Teresa LC, Kuschnir E, Sgammini H, Sgammini J, David J, Sosa CH, Redcozub E, Avalos V, Nul D, Ramos S, Castro PT, Rodriguez A, Sosa C, Lopez JG, Novo F, Diez F, Piraino R, Godoy G, Weller C, Pomposiello J, Sanchez A, Karlsson J, Collberg K, Malmqvist K, Cedergren E, Dellborg M, Coops G, Kallryd A, Laudon P, Bandh S, Andersson C, Soome S, Classon H, Lugnegard J, Ahlmark H, Risenfors M, Ortgren L, Fjelstad B, Osberg S, Frisell J, Sandstrom M, Silvestri O, Sasso A, Rolli A, Paoli G, Chiarella F, Olivotte L, Doronzo B, Coppolino A, Pivoccari G, Pesaresi A, Ambrosio G, Del Pinto M, De Luca I, Laico M, De Ferrari G, Baldini E, Guiducci U, Tortorella G, Romano M, Villani R, Casazza F, Capozi A, Moretti L, Del Pinto M, Perelli S, Sinagra G, Maras P, Porcu M, Scorcu G, Proietti F, Severi S, Gessek J, Pawlowicz L, Szelemej R, Gorski M, Janion M, Sielski J, Kleinrok A, Rodzik J, Hiczkiewicz J, Pasler MM, Soltsiak M, Gorny J, Huber K, Jordanova N, Heigert M, Kopp K, Frank H, Laggner A, Schreiber W, Weihs W, Drexel MH, Doubell A, Burgess L, Bennett J, Snyders F, Ebrahim I, Bobak C, Marx J, deBeer M, Schmidt S, Cyster H, van der Berg P, Groenewald W, Herbst L, Britz A, Snyman M, Schonken M, Badenhorst J, Blomerus P, Mpe M, Bobak C, Mynhardt J, Groenewald C, van Dyk C, Meiring J, Steingo L, Glaeser L, Whelan A, Tulloch G, Gunalingham B, Conway B, Soward A, Hales S, Lefkovits J, Sallaberger M, Owesby D, Kesby J, Amerena J, Fogarty K, Chew D, Austin M, Kovaricek S, Banham N, Tulloch G, Jobbagy L, Dinnyes J, Lippai J, Oze B, Szakal I, Bartal G, Foldi A, Foley D, McGrath F, Meany B, Geraghty M, Daly K, Henessey S, Mulvihill N, Schilling C, Kearney P, Kelly P, Kearney P, Kelly P, Ongen Z, Vura A, Kozan O, Ozaydin E, Kultursay H, Kayikcioglu M, Degertekin M, Mutlu B, Monteiro F, Ferreira D, Carrageta M |
| Source: NEW ENGLAND JOURNAL OF MEDICINE Volume: 352 Issue: 12 Pages: 1179-1189 Published: MAR 24 2005 |
| Times Cited: 439 References: 34 |
| Abstract: BACKGROUND: A substantial proportion of patients receiving fibrinolytic therapy for myocardial infarction with ST-segment elevation have inadequate reperfusion or reocclusion of the infarct-related artery, leading to an increased risk of complications and death.
METHODS:
We enrolled 3491 patients, 18 to 75 years of age, who presented within 12 hours after the onset of an ST-elevation myocardial infarction and randomly assigned them to receive clopidogrel (300-mg loading dose, followed by 75 mg once daily) or placebo. Patients received a fibrinolytic agent, aspirin, and when appropriate, heparin (dispensed according to body weight) and were scheduled to undergo angiography 48 to 192 hours after the start of study medication. The primary efficacy end point was a composite of an occluded infarct-related artery (defined by a Thrombolysis in Myocardial Infarction flow grade of 0 or 1) on angiography or death or recurrent myocardial infarction before angiography.
RESULTS:
The rates of the primary efficacy end point were 21.7 percent in the placebo group and 15.0 percent in the clopidogrel group, representing an absolute reduction of 6.7 percentage points in the rate and a 36 percent reduction in the odds of the end point with clopidogrel therapy (95 percent confidence interval, 24 to 47 percent; P<0.001). By 30 days, clopidogrel therapy reduced the odds of the composite end point of death from cardiovascular causes, recurrent myocardial infarction, or recurrent ischemia leading to the need for urgent revascularization by 20 percent (from 14.1 to 11.6 percent, P=0.03). The rates of major bleeding and intracranial hemorrhage were similar in the two groups.
CONCLUSIONS:
In patients 75 years of age or younger who have myocardial infarction with ST-segment elevation and who receive aspirin and a standard fibrinolytic regimen, the addition of clopidogrel improves the patency rate of the infarct-related artery and reduces ischemic complications.
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| Document Type: Article |
| Language: English |
| Reprint Address: Sabatine, MS (reprint author), Brigham & Womens Hosp, Div Cardiovasc, TIMI Study Grp, Dept Med, 75 Francis St, Boston, MA 02115 USA |
Addresses:
1. Brigham & Womens Hosp, Div Cardiovasc, TIMI Study Grp, Dept Med, Boston, MA 02115 USA
2. Harvard Univ, Sch Med, Boston, MA USA
3. Hosp Univ Gregorio Maranon, Madrid, Spain
4. Hop La Pitie Salpetriere, Inst Cardiol, Paris, France
5. Montreal Heart Inst, Montreal, PQ H1T 1C8 Canada
6. Univ Antwerp Hosp, Dept Cardiol, Edegem, Belgium
7. Acad Ziekenhuis Klina, Brasschaat, Belgium
8. Nottingham Clin Res Grp, Nottingham, England |
| Publisher: MASSACHUSETTS MEDICAL SOC, WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA |
| Subject Category: Medicine, General & Internal |
| IDS Number: 909AW |
| ISSN: 0028-4793 |
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| | | | | | | | | Record from Web of Science® | | | | | | | | | |