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CLOpidogrel & Metoprolol in Myocardial Infarction Trial (COMMIT)
45,853 patients in China presenting within 24 hours of suspected myocardial infarction.
All patients received standard treatment, including aspirin.
1/2 of the patients received fibrinolytic therapy.
96% with confirmed myocardial infarction
87% with ST-segment elevation on EKG
24% with moderate heart failure on entry
Study funded by manufacturer of both drugs
Treatment groups:
1) Oral clopidogrel 75 mg immediately, then daily
2) metoprolol 5-15 mg IV bolus, then infusion titrated to heart rate > 50/min, systolic blood pressure > 90 mm Hg then 200 mg PO QD
3) both clopidogrel & metoprolol
4) neither
Endpoints:
1) death, reinfarction, cardiac arrest, stroke
2) endpoints recorded at hospital discharge or at 28 days whichever came 1st
Results:
1) patients who received clopidogrel vs those that did not with lower composite outcome of death, reinfarction or stroke 9.2% vs 10.1% & all-cause mortality 7.5% vs 8.1%
- no significant increase in bleeding with clopidgrel
2) patients who received metoprolol vs those that did not had fewer reinfarctions (2.0 vs 2.5%), fewer episodes of ventricular fibrillation (2.5% vs 3.0%) & more episodes of cardiogenic shock (5.0% vs 3.9%),
- fewer deaths from arrhythmias (1.7% vs 2.2%)
- more deaths from cardiogenic shock (2.2% vs 1.7%)
- no change in all-cause mortality
3) most of the excess risk occurred on the 1st day
4) most of the benefit emerged after day 2
General
clinical trial
References
- COMMIT (CLOpidogrel and Metoprolol in Myocardial Infarction
Trial) Collaborative Group.
Addition of clopidogrel to aspirin in 45,852 patients with
myocardial infarction: Randomized placebo-controlled trial.
Lancet 2005;1607
PMID: 16271642
- COMMIT (CLOpidogrel and Metoprolol in Myocardial Infarction
Trial) Collaborative Group.
Early intravenous the oral metoprolol in 45,852 patients with
myocardial infarction: Randomized placebo-controlled trial.
Lancet 2005;1622
PMID: 16271643
- Sabatine MS.
Something old, something new: beta-blockers and clopidogrel
in acute myocardial infarction
PMID: 16271628