COMMIT
ClOpidogrel and Metoprolol in Myocardial Infarction Trial (Second Chinese Cardiac Study, CCS-2)
Patient / Population Intervention / Exposition Comparaison Critère de jugement
In 45,852 patients with acute myocardial infarction, clopidogrel added to aspirin reduced death, reinfarction, or stroke compared with placebo.
N
45 852
Schéma
Randomised, double-blind, placebo-controlled RCT, 2×2 factorial
Critère
Co-primary: death, reinfarction, or stroke; and death from any cause
Pertinence
2
RésultatAdding clopidogrel to aspirin reduced death/reinfarction/stroke 9.2% vs 10.1% (9% reduction, P=0.002) and all-cause death 7.5% vs 8.1% (7% reduction, P=0.03) without excess major bleeding. Factorial metoprolol arm neutral and increased cardiogenic shock.
Chen ZM, et al. Lancet. 2005;366(9497):1607-21. 10.1016/S0140-6736(05)67660-X
Discussion et critique
Used no loading dose and only ~2 weeks of in-hospital treatment in a predominantly fibrinolytic-treated population. Established adding clopidogrel to aspirin as routine in acute MI, a foundation of dual antiplatelet therapy.