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Evidence-Based Medicine 2006;11:82-83; doi:10.1136/ebm.11.3.82
Copyright © 2006 by the BMJ Publishing Group Ltd.
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Therapeutics

Addition of clopidogrel to aspirin, but not early use of metoprolol, improved overall outcome in acute myocardial infarction

COMMIT Collaborative Group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366:1607–21.COMMIT Collaborative Group. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366:1622–32.[CrossRef][Medline]

Q In patients hospitalised within 24 hours of suspected acute myocardial infarction (AMI), does the addition of clopidogrel to aspirin and the early use of metoprolol improve outcomes?

Clinical impact ratings IM/Ambulatory care ******* Internal medicine ******{star} Cardiology ******* Emergency medicine ******{star}

Key Words: myocardial infarction • platelet aggregation inhibitors • ticlopidine • aspirin • anti-inflammatory agents (non-steroidal) • adrenergic beta-antagonists • metoprolol

The first 150 words of the full text of this article appear below.

METHODS
Formula Design randomised placebo controlled trial with 2 x 2 factorial design (Clopidogrel and Metoprolol in Myocardial Infarction Trial [COMMIT]).

Formula Allocation concealed.*

Formula Blinding blinded {clinicians, patients, and outcome assessors}{dagger}.*

Formula Follow up period until first hospital discharge or 28 days.

Formula Setting 1250 hospitals in China.

Formula Patients 45 852 patients (mean age 61 y, 72% men) hospitalised within 24 hours (mean 10 h) of onset of symptoms of AMI, with ST elevation (87%), left bundle branch block (6%), or ST depression (7%) and no clear indication for or against the study medications. Those with moderate heart failure were eligible. Patients scheduled for primary percutaneous coronary intervention (PCI) and those with small likelihood of benefit or high risk for adverse effects were excluded.

Formula Interventions clopidogrel, 75 mg once daily (n = 22 961), or placebo (n = 22 891); all patients also received aspirin, 162 mg once daily. Intravenous (IV) metoprolol, 5 mg, . . . [Full text of this article]

David Massel, MD, FRCPC

T London Health Sciences Centre
London, Ontario, Canada


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Glossary
Evid. Based Med. 2006 11: 95a. (in Glossary) [Extract] [Full Text] [PDF]





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Copyright © 2006 by the BMJ Publishing Group Ltd.