Clopidogrel in addition to aspirin reduces one‐year major adverse cardiac and cerebrovascular events in unselected patients with non‐ST segment elevation myocardial infarction

OBJECTIVES: We sought to assess the effect of clopidogrel on one-year ischemic events in unselected patients with NSTEMI. METHODS: We analysed data of consecutive patients with acute NSTEMI treated with aspirin or aspirin plus clopidogrel, who were prospectively enrolled in the ACOS registry. RESULTS: A total of 4290 patients were included, 2171 were treated with aspirin and 2119 with aspirin plus clopidogrel. In the univariate analysis in-hospital (13.7% versus 6.3%, P<0.001) and one-year (28.1% versus 15.6 %, P<0.001) mortality and the combined endpoint of death, non-fatal myocardial infarction and non-fatal stroke was significantly lower in the clopidogrel group. There was a significant increase in in-hospital bleeding complications with clopidogrel (5.4 % versus 3.3 %, P<0.05). In the multivariable propensity score analysis adjusted for baseline variables the odds ratio for the one-year combined endpoint was significantly reduced (odds ratio 0.69, 95% CI: 0.64-0.74) in the aspirin plus clopidogrel group. CONCLUSION: In clinical practice, early therapy with clopidogrel, in addition, to aspirin in patients with NSTEMI is associated with a significant reduction of the combined endpoint of death, non-fatal reinfarction and non-fatal stroke after one year. This advantage was associated with an increase in major in-hospital bleeding complications.