Background— Although treatment with immediate aspirin reduces morbidity and mortality in ST-elevation myocardial infarction, the optimal dose is unclear. We therefore compared the acute mortality and bleeding risks associated with the initial use of 162 versus 325 mg aspirin in fibrinolytic-treated ST-elevation myocardial infarction patients. Methods and Results— Using combined data from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary ... ARMYDA-6 MI demonstrates that a 600-mg clopidogrel loading dose is safe and more effective than the 300-mg regimen in the context of primary PCI for STEMI. The results provide a randomized contribution supporting the use of 600 mg clopidogrel as the loading dose of choice in these patients. The first goal for healthcare professionals in management of acute myocardial infarction (MI) is to diagnose the condition in a very rapid manner. As a general rule, initial therapy for acute MI is directed toward restoration of perfusion as soon as possible to salvage as much of the jeopardized myocardium as possible. This may be accomplished through medical or mechanical means, such as percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) surgery. A 300-mg clopidogrel loading dose followed by 75 mg daily in addition to aspirin has also proven beneficial over aspirin alone in patients with acute myocardial infarction (MI) treated with fibrinolytic therapy (15, 16). Neither loading dose of clopidogrel has been studied in patients with acute MI undergoing primary PCI.
