ANTIPLATELET THERAPY IS EFFECTIVE IN PRIMARY PREVENTION OF MYOCARDIAL-INFARCTION IN PATIENTS WITH A PREVIOUS CEREBROVASCULAR ISCHEMIC EVENT

Objective.-A secondary subgroup analysis of the European Stroke Preven tion Study of the effect of antiplatelet medication on the risk of myo cardial infarction. Design and Setting.-A randomized, double-blind, pl acebo-controlled study with two parallel treatment groups (dipyridamol e plus aspirin and placebo). Sixteen centers from six countries partic ipated in the study. Patients.-A total of 2500 patients who had had on e or more transient ischemic attacks or cerebral infarctions participa ted. 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 f atal and nonfatal myocardial infarction. Results.-A total of 105 myoca rdial infarctions occurred in the intention-to-treat analysis and 76 o ccurred in the explanatory analysis. The overall risk reduction of myo cardial infarction with the study drugs was approximately 40% in both statistical analyses, but the result was statistically significant onl y 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 a spirin reduces not only the risk of cerebrovascular ischemic events bu t also the risk of myocardial infarction.