The Pharmaceutical Journal
Vol 269 No 7226 p772
30 November 2002

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American Heart Association (more)

"Cooling off" period no benefit in ACS

Patients with acute coronary syndromes at high risk of heart attack or stroke do not benefit from extended antithrombotic treatment before angioplasty, according to data presented at the American Heart Association scientific sessions in Chicago last week.

A group of 410 patients with unstable coronary syndromes were given extended antithrombotic pre-treatment (72–120 hours) or early intervention with pre-treatment for less than six hours. All received the same antithrombotic treatment — aspirin, clopidogrel (Plavix) and heparin.

After 30 days, three deaths and 21 non-fatal myocardial infarctions had occurred in the cooling-off group, compared with no deaths and 12 myocardial infarctions in the early intervention group (relative risk 2.0, 95 per cent confidence interval, 1.01–3.94, P=0.04). After catheterisation, 11 events (death or MI) had occurred in each group.

Study lead Dr Franz-Josef Neumann, Bad Krozingen Heart Centre, Germany, said: "This means that we cannot detect an effect of pre-treatment on risk reduction for the subsequent intervention. Pre-treatment is not needed and even increases the risk to patients."