COMMIT-CCS 2

Jump to navigation Jump to search

WikiDoc Resources for COMMIT-CCS 2

Articles

Most recent articles on COMMIT-CCS 2

Most cited articles on COMMIT-CCS 2

Review articles on COMMIT-CCS 2

Articles on COMMIT-CCS 2 in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on COMMIT-CCS 2

Images of COMMIT-CCS 2

Photos of COMMIT-CCS 2

Podcasts & MP3s on COMMIT-CCS 2

Videos on COMMIT-CCS 2

Evidence Based Medicine

Cochrane Collaboration on COMMIT-CCS 2

Bandolier on COMMIT-CCS 2

TRIP on COMMIT-CCS 2

Clinical Trials

Ongoing Trials on COMMIT-CCS 2 at Clinical Trials.gov

Trial results on COMMIT-CCS 2

Clinical Trials on COMMIT-CCS 2 at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on COMMIT-CCS 2

NICE Guidance on COMMIT-CCS 2

NHS PRODIGY Guidance

FDA on COMMIT-CCS 2

CDC on COMMIT-CCS 2

Books

Books on COMMIT-CCS 2

News

COMMIT-CCS 2 in the news

Be alerted to news on COMMIT-CCS 2

News trends on COMMIT-CCS 2

Commentary

Blogs on COMMIT-CCS 2

Definitions

Definitions of COMMIT-CCS 2

Patient Resources / Community

Patient resources on COMMIT-CCS 2

Discussion groups on COMMIT-CCS 2

Patient Handouts on COMMIT-CCS 2

Directions to Hospitals Treating COMMIT-CCS 2

Risk calculators and risk factors for COMMIT-CCS 2

Healthcare Provider Resources

Symptoms of COMMIT-CCS 2

Causes & Risk Factors for COMMIT-CCS 2

Diagnostic studies for COMMIT-CCS 2

Treatment of COMMIT-CCS 2

Continuing Medical Education (CME)

CME Programs on COMMIT-CCS 2

International

COMMIT-CCS 2 en Espanol

COMMIT-CCS 2 en Francais

Business

COMMIT-CCS 2 in the Marketplace

Patents on COMMIT-CCS 2

Experimental / Informatics

List of terms related to COMMIT-CCS 2

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]


COMMIT-CCS 2: Clopidogrel and Metoprolol in Myocardial Infarction Trial-Second Chinese Cardiac Study

Overview

The cardioprotective effects of aspirin in patients with acute myocardial infarction (MI) have been well established. However, whether the routine administration of the ADP inhibitor clopidogrel (Plavix, Sanofi-Aventis and Bristol-Myers Squibb) together with aspirin adds further protection has not been assessed in a randomized, controlled study.

Study Design

The Clopidogrel and Metoprolol in Myocardial Infarction Trial-Second Chinese Cardiac Study (COMMIT-CCS 2) is the largest clinical study ever conducted in China; it enrolled 45,852 patients at 1250 centers in China. COMMIT-CCS 2 was a randomized, parallel controlled trial that used a 2 x 2 factorial design to assess the effects of adding 75 mg of clopidogrel (vs. placebo) and the effects of adding the beta blocker, metoprolol (vs. placebo) in acute MI patients on aspirin therapy (162 mg daily).

Patients with suspected AMI (ST change or new left bundle branch block) within 24 hours of symptom onset were enrolled in the study; patients undergoing primary PCI or those with a high risk of bleeding were excluded.

Primary endpoint: Death and the composite of death, reinfarction, and stroke up to 4 weeks in hospital or prior to discharge.

Mean treatment duration and follow-up was 16 days.

Results

A total of 22,960 patients were randomized to clopidogrel 75 mg daily and 22,891 patients were randomized to placebo; all patients were treated with aspirin. Baseline characteristics were well balanced between study groups. In each group, 26% of patients were older than 70 years of age, 34% were randomized within 6 hours of symptom onset, and fibrinolytic therapy was administered in 50% of patients, including 68% of ST segment elevation MI patients presenting within 12 hours. Other concomitant drug therapies were well used, and prescribing patterns among Chinese physicians matched those used in Western countries.

ACE = angiotensin converting enzyme; LBBB = left bundle branch block; STEMI = ST elevation myocardial infarction

The incidence of the study's primary composite endpoint (death, reinfarction, stroke) was significantly lower in the clopidogrel arm than in the control arm (10.1% vs 9.3%, 2P =0.002). This significant difference translated into a 9% reduction in the relative risk of the composite endpoint.

A total of 1728 (7.7%) in-hospital deaths were reported in the clopidogrel group vs 1846 (8.1%) in-hospital deaths in the control group, accounting for a 7% relative risk reduction (2p=0.03).

Clopidogrel was also found to reduce the risk of reinfarction by 13% relative to placebo (2p=0.02) and reduced the risk of all strokes by 14%, but the difference did not reach statistical significance, which was mostly attributable to a reduced incidence of ischemic stroke. In addition, there was no difference in the rate of major bleeding events between the 2 groups.

The treatment effect of clopidogrel on the primary endpoint occurred relatively quickly, with a 10% reduction in favor of clopidogrel within 12 hours, and with each additional day, there was further benefit.

The risk reduction in the primary endpoint with clopidogrel vs placebo remained consistent across all prespecified subgroups, including those treated and not treated with lytic therapy. There was a slight trend suggesting that greater benefit was achieved when the study drug was administered within 6 hours.

Conclusions

  • There was no excess of cerebral, fatal, or transfused bleeds.
  • Each million [[acute myocardial infarction] patients treated for approximately 2 weeks would avoid 5000 deaths and 5000 nonfatal deaths.

Reference

Additional and up-to-dated Information about all Cardiovascular Trials

Template:WikiDoc Sources