Aspirin and Recurrent Myocardial Infarction

WITH the recent acceptance by the Food and Drug Administration of controlled clinical trials that establish the safety and efficacy of aspirin for control of transient ischemic attacks in the cerebral circulation and reducing the risk of their progression to stroke,^1,2 one might expect similar protective effects on the coronary circulation. For several years it has been suggested that patients who habitually use aspirin are less liable to have development of myocardial infarction.³ Three earlier randomized controlled trials^4-6 provided suggestive evidence in support of using aspirin as prophylaxis in coronary heart disease (CHD), but in none did the difference in mortality between the control and experimental groups achieve statistical significance (P<.05). These led to three more trials that have recently seen publication: a trial sponsored by the Medical Research Council (MRC) Epidemiology Unit of South Wales,⁷ the Aspirin Myocardial Infarction Study (AMIS) sponsored by the