In patients who have myocardial infarction with ST-segment elevation,rupture of an atherosclerotic plaque leads to platelet adhesion,activation, and aggregation, with subsequent vessel occlusiondue to thrombus formation. In these circumstances, the mosteffective pharmacologic reperfusion regimen is concurrent fibrinolytictherapy and platelet inhibition. The marked benefit of sucha combination was first established in the Second InternationalStudy of Infarct Survival, in which 35-day mortality among patientswith suspected myocardial infarction was 13.2 percent for thosereceiving neither streptokinase nor aspirin, approximately 10.5percent for those given one or the other, and 8.0 percent forthose receiving both . . . [Full Text of this Article]
Source Information
From the Cardiology Division, Department of Internal Medicine, Johns Hopkins Medical Institution, Baltimore (R.A.L.), and the University of Texas Southwestern Medical Center, Dallas (L.D.H.).
This article was published at www.nejm.org on March 9, 2005.
This article has been cited by other articles:
Eshaghian, S., Kaul, S., Amin, S., Shah, P. K., Diamond, G. A.
(2007). Role of Clopidogrel in Managing Atherothrombotic Cardiovascular Disease. ANN INTERN MED
146: 434-441
[Abstract][Full Text]
Cannon, C. P., Mehta, S. R., Aranki, S. F.
(2005). Balancing the Benefit and Risk of Oral Antiplatelet Agents in Coronary Artery Bypass Surgery. Ann. Thorac. Surg.
80: 768-779
[Abstract][Full Text]
(2005). Does Clopidogrel Add Benefit to Fibrinolytic Therapy and Aspirin in STEMI?. JWatch Emergency Med.
2005: 2-2
[Full Text]
Previous
