COMMIT研究-氯吡格雷&美托洛尔心肌梗死试验PPT课件.ppt

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1、COMMIT/CCS-2:ClOpidogrel&MetoprololinMyocardialInfarctionTrialBeijing(48)Shanghai(16)Tianjin(21)Shanxi(58)Hebei(115)Liaoning(92)Jilin(50)Heilongjiang(53)Jiangsu(63)Anhui(28)Shandong(148)Zhejiang(12)Jiangxi(20)Fujian(22)Hunan(37)Hubei(54)Henan(121)Guangdong(49)

2、Guizhou(11)Hainan(7)Sichuan(49)Yunnan(12)Shaanxi(43)Gansu(25)Qinghai(4)NeiMongol(38)Guangxi(30)Ningxia(8)Xinjiang(7)Chongqing(11)COMMIT:45,852patientsfrom1250centresinChinaTREATMENT:Clopidogrel75mgdailyvsplacebo(aspirin162mgdailyinbothgroups)INCLUSION:Suspecte

3、dacuteMI(STchangeorLBBB)within24hofsymptomonsetEXCLUSION:PrimaryPCIorhigh-riskofbleeding1OUTCOMES:Death&death,re-MIorstrokeupto4weeksinhospital(orpriordischarge)Meantreatmentandfollow-up:16daysCOMMIT:StudydesignCharacteristicClopidogrelPlacebo(n=22,960)(n=22,

4、891)Age70+y26.0%26.0%Female27.7%27.9%Timedelay<6h33.8%33.7%STEMI/LBBB93.1%93.1%KillipclassII/III24.1%24.0%Fibrinolytic:Allpatients49.7%49.8%STEMI<12h67.8%67.7%COMMIT:BaselinecharacteristicsTherapyClopidogrelPlacebo(n=22,958)(n=22,891)Anticoagulants74.1%75.0%AC

5、Einhibitors68.2%68.3%Anti-arrhythmics22.4%22.2%Nitrates94.1%94.3%Diuretics23.3%23.3%Calciumantagonists11.8%11.8%COMMIT:ConcomitanttherapyCOMMIT:EffectsofCLOPIDOGRELonDeath,Re-MIorStrokeDayssincerandomisation(upto28days)Event(%)9%(SE3)relativeriskreduction(2P=0

6、.002)Placebo+ASA:2311events(10.1%)Clopidogrel+ASA:2125events(9.3%)COMMIT:EffectofCLOPIDOGRELonDeathinhospitalDead(%)Dayssincerandomisation(upto28days)Placebo+ASA:1846deaths(8.1%)Clopidogrel+ASA:1728deaths(7.5%)7%(SE3)relativeriskreduction(2P=0.03)COMMIT:Effec

7、tsofCLOPIDOGRELonReinfarctionClopidogrelPlaceboOddsratio&95%CIClopid.betterPlacebobetterOutcomeafterRe-MI(22,958)(22,891)Died209223(0.9%)(1.0%)Survived273330(1.2%)(1.4%)ALLCOMBINED482553(2.1%)(2.4%)13%SE6(2P=0.02)0.40.60.81.01.21.41.6COMMIT:EffectsofCLOPIDOGRE

8、LonanyStrokeClopidogrelPlaceboOddsratio&95%CIClopid.betterPlacebobetterTypes(22,958)(22,891)Ischaemic162192(0.7%)(0.8%)Haemorrhagic5555(0.2%)(0.2%)ALLCOMBINED216249(0.9%)(1.1%)14%S