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The drug ad applies to the next 2 items.

The 3-page drug ad is focused on Efrenzia, a novel anti-platelet agent for the treatment of acute coronary syndrome.

Item 1 of 2

A 58-year-old man with a history of hypertension and type 2 diabetes mellitus comes to the emergency department because of chest pain and diaphoresis.  The symptoms started 2 hours ago and have a stuttering course.  He has never had similar symptoms before.  In the emergency department, his electrocardiogram shows horizontal ST segment depression in leads V1 to V4.  He is given the appropriate medical therapy including low-dose aspirin and referred to the catheterization laboratory due to persistence of his angina.  Based on the information provided in the drug ad, giving the patient Efrenzia as opposed to clopidogrel would most likely decrease the risk of developing which of the following events?

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Explanation:

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This drug ad is comparing the effect of administering Efrenzia + aspirin versus clopidogrel + aspirin for patients with acute coronary syndrome undergoing percutaneous coronary intervention.  Patients were divided into 2 groups: those with unstable angina (UA)/non-ST elevation myocardial infarction (NSTEMI) and those with ST-elevation myocardial infarction (STEMI).  The results are reported as the percentage of patients developing a composite endpoint of cardiovascular death, non-fatal myocardial infarction (MI), or nonfatal stroke over the subsequent 18 months.  A subgroup analysis was also performed in patients with diabetes who had UA/NSTEMI or STEMI.

There was a 2.7% overall decrease of events in patients with STEMI (12.4% reduced to 9.7%) and a 1.8% decrease of events in patients with UA/NSTEMI (10.7% reduced to 8.9%).  The third page of the drug ad indicates that the difference between the treatments was primarily due to a reduction in non-fatal MIs; there was no significant difference in cardiovascular death or non-fatal stroke (Choices A and C).  As a result, giving this patient Efrenzia as opposed to clopidogrel would most likely decrease his risk of having another (ie, recurrent) MI.

(Choice B)  Major bleeding was not part of the primary composite endpoint.  Also, the safety data at the end of the drug ad indicates that overall bleeding rates were significantly increased with Efrenzia.

Educational objective:
When comparing the effects of a treatment on a composite outcome, it is important to note any differences between the individual endpoints.