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.
Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation / 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; 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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. - In: THE NEW ENGLAND JOURNAL OF MEDICINE. - ISSN 0028-4793. - 352:12(2005), pp. 1179-1189. [10.1056/NEJMoa050522]
Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation
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
2005-01-01
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.
Citazione
Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation / 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; 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[10.1056/NEJMoa050522]
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Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande. La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.