In a new meta-analysis, early management of non–ST-segment elevation myocardial infarctions with thienopyridines was not associated with significantly lower mortality and did not lower major adverse cardiovascular event rates for those eventually undergoing PCI.
Current ACC/AHA guidelines support dual antiplatelet treatment upstream with aspirin and thienopyridines (e.g., clopidogrel) for patients with unstable angina or non–ST-segment elevation myocardial infarction (NSTEMI). Now, a new meta-analysis of more than 32,000 patients, analyzed data from available randomized trials and from registries to assess the effect of thienopyridine treatment on outcomes, both in patients who underwent subsequent percutaneous interventions (PCIs) and in those who were treated medically.
Results show that pretreatment with thienopyridines was not associated with significantly lower mortality but was associated with significantly fewer major adverse cardiovascular events (MACE; odds ratio, 0.84). However, thienopyridine therapy also was associated with significantly more major bleeding (OR, 1.32). Of note, in the subset of patients who underwent PCIs, mortality and MACE were essentially the same in those who received thienopyridine pretreatment vs those who did not.