- Question
- Does adding clopidogrel to standard aspirin therapy reduce mortality and major vascular events in patients with acute myocardial infarction, most of them with ST-segment elevation?
- Design
- Randomised, double-blind, placebo-controlled trial of 45852 patients admitted to 1250 hospitals within 24 h of suspected MI onset. Analysis was by intention to treat.
- Population
- Patients with suspected acute myocardial infarction of up to 24 h duration; 93% had ST-segment elevation or bundle branch block and 7% had ST-segment depression.
- Intervention
- Clopidogrel 75 mg daily on top of aspirin 162 mg daily, continued until discharge or up to 4 weeks in hospital (mean 15 days in survivors).
- Control
- Matching placebo plus aspirin 162 mg daily.
- Primary outcome
- Two prespecified co-primary outcomes: (1) the composite of death, reinfarction, or stroke; and (2) death from any cause during the scheduled treatment period.
- Results
- Clopidogrel produced a 9% (95% CI 3-14) proportional reduction in death, reinfarction, or stroke (9.2% vs 10.1%; p=0.002), about nine fewer events per 1000 patients treated for roughly 2 weeks. All-cause death was also reduced by 7% (95% CI 1-13) (7.5% vs 8.1%; p=0.03).
- Safety
- No significant excess of fatal, transfused, or cerebral bleeds combined (0.58% vs 0.55%; p=0.59), including in patients older than 70 years and those given fibrinolytic therapy.
- Conclusion
- Adding clopidogrel to aspirin and other standard treatments safely reduces in-hospital mortality and major vascular events in acute MI.
- Why it matters
- It supported adding clopidogrel to dual antiplatelet therapy from the acute phase of ST-elevation MI, including in patients receiving fibrinolysis.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026