Antiplatelet therapy is effective in primary prevention of myocardial infarction in patients with a previous cerebrovascular ischemic event

J. Sivenius, P. J. Riekkinen, A. Lowenthal, P. Smets and M. Laakso
Department of Neurology, University of Kuopio Finland.

OBJECTIVE--A secondary subgroup analysis of the European Stroke Prevention Study of the effect of antiplatelet medication on the risk of myocardial infarction. DESIGN AND SETTING--A randomized, double-blind placebo-controlled study with two parallel treatment groups (dipyridamole plus aspirin and placebo). Sixteen centers from six countries participated in the study. PATIENTS--A total of 2500 patients who had had one or more transient ischemic attacks or cerebral infarctions participated. INTERVENTION--Combination therapy with dipyridamole (75 mg three times a day) and aspirin (330 mg three times a day) was compared with placebo during 24 months' follow-up. OUTCOME MEASURES--Prevention of fatal and nonfatal myocardial infarction. RESULTS--A total of 105 myocardial infarctions occurred in the intention-to-treat analysis and 76 occurred in the explanatory analysis. The overall risk reduction of myocardial infarction with the study drugs was approximately 40% in both statistical analyses, but the result was statistically significant only in the intention-to-treat analysis. Therapeutic efficacy was better among male patients, patients younger than 65 years, and patients with hypertension. CONCLUSION--Combination therapy with dipyridamole and aspirin reduces not only the risk of cerebrovascular ischemic events but also the risk of myocardial infarction.