An acquaintance asked me if I could get some information. Afterwards I thought it might be useful for others.

He’d had some tightness in chest while riding his bike. His hospital discharge letter mentioned possible ST elevation in the first ECG, heart tracing, but not on the following ones. He had normal troponin on admission but rising later. Angiogram showed evidence of coronary artery disease. 

Put the above all together, it looks like an ischaemic episode in your heart, a minor heart attack or maybe first episode of angina (do enzymes elevate with angina?)

The ECG sounds a bit equivocal – not classical. ST elevation doesn’t usually go away that soon. 

The angio findings hmm – don’t think anyone knows if you take a few hundred symptomless men of your age off the street, what percentage have findings like yours and then what percentage of these folk who go on to have heart attacks. What’s normal in a 70 year old.

There are other causes of troponin elevation besides coronary artery disease see here. Ie cocaine, over the top exercise,broken heart syndrome (my sister had this). 

Let’s say it was an ischaemic episode; when you read about prevention, looking after yourself in the future, you’d be looking at what’s called secondary prevention – primary being no history of heart issues. 

here’s a review for aspirin for folk post heart attack 

Here’s one for adding clopidogrelto aspirin given during and after the event.

Here’s one with clopidogrel added to aspirin

clopidogrel alone

here’s one for Meditaranean dietwhatever that is

Here’s oneon statins for post heart event.

Here’s an audio onhigh versus low dose statinand another

You will have been labelled as having an ACS event – acute coronary syndrome. Your ECG showed ? st elevation not seen in later ECGs. When you are searching stuff the question is did you have a STEMI or NONSTEMI – ie st elevation heart attack or not. Not sure what difference this makes to taking both aspirin and clopidogrel but you could ask? Makes a big difference as to whether to have a stent or not.

There is debate about how long to stay on both aspirin and clopigogrel. It does increase risk of brain and other bleeds. My sister was on dual and probably didn’t need to be and died from a brain bleed. 

To help with info below. ARI absolute risk increase. NNH number needed to harm ie 1 in 29 above. NNT number needed to treat. An NNT of 48 means 48 take treatment for one to benefit. 

Adding clopidogrel to aspirin was also associated with a significantly increased incidence of bleeding episodes (8.5% vs. 5.0%, ARI= 3.5%, NNH= 29), despite exclusion of patients judged “at high risk of bleeding”. There was an increase in both, major (3.7% vs. 2.7%, ARI= 1%, NNH= 100) and minor bleeding episodes (5.1% vs. 2.4%, ARI= 2.7%, NNH= 37). Approximately half of the total excessive major bleeds in the clopidogrel plus aspirin group occurred during the first month of therapy (2.0% vs. 1.5%, ARI= 0.5%, NNH= 200).

same reference

Compared with placebo plus aspirin, clopidogrel plus aspirin significantly reduced the absolute risk of the first primary outcome, which was defined as the composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke (9.3% vs. 11.4%, ARR =2.1%, NNT =48). About half of the total absolute risk reduction in the first primary outcome was already achieved after 1 month of therapy (4.3% vs. 5.4%, ARR =1.1%, NNT=91). The number of pills needed to prevent 1 event in the first month was 3003 (Calculated based on 91 patients needed to treat for 30 days and taking into consideration the recommended dose (300 mg = 4 pills the first day of therapy, and 75 mg = 1 pill for each day afterwards). An average of 8 more months of combined therapy with clopidogrel plus aspirin was required to achieve the additional half of the absolute risk reduction. The number of pills needed to prevent 1 event during the duration of the entire trial was 13,104 (Calculated based on 48 patients needed to treat for a mean of 9 months and taking into consideration the recommended dose (300 mg = 4 pills the first day of therapy, and 75 mg = 1 pill for each day afterwards).

So There we go

You probably had a non specific coronary event, actual cause ? Your coronary arteries aren’t childlike. Was this an angina like event due to narrowing. Or was it a thrombotic event, ie a clotting event. My sisters were normal and she smoked and ate animal fat in huge amounts and hardly did any exercise. 

Taking statins and aspirin is a no brainers. 

Questions for you

high dose versus low dose statins

how long to stay on dual therapy. 

No cocaine

gentle exercise versus vigorous 

Mediterranean style diet – ? what this is exactly.

Hope this helps.