Clopidogrel for STEMI vs NSTEMI

[Maxilla54]

Why is it recommended that clopidogrel is only continued for 1month following STEMI vs 1year for NSTEMI? (in addition to aspirin indefinitely for both + ACEi, BB, statin). I would've thought STEMI represents more significant vascular disease hence would require longer antiplatelet tx.

UK guidelines here, but wondering whether anyone can figure out the rationale from first principles?

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[Styrene]

There is no explanation from first principles. Just from a brief review of the literature, these guidelines are derived from various trials, namely TRITON-TIMI 38. Generally, NSTEMI patients have higher mortality year on year than STEMI patients due to multiple factors, including differential provider treatment patterns and NSTEMI patient characteristic heterogeneity.

 

[Maxilla54]

There is no explanation from first principles. Just from a brief review of the literature, these guidelines are derived from various trials, namely TRITON-TIMI 38. Generally, NSTEMI patients have higher mortality year on year than STEMI patients due to multiple factors, including differential provider treatment patterns and NSTEMI patient characteristic heterogeneity.

Fair enough - thanks for your reply!
Didn't know that about NSTEMI - I wonder if it's the same in the UK...

 

[Styrene]

Fair enough - thanks for your reply!
Didn't know that about NSTEMI - I wonder if it's the same in the UK...

It's a multicenter trial across 30 countries with 26% of study subjects from western Europe, so assuming the results of the trial are correct, then yes.