Authors
COMMIT collaborative group
Title
Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial.
References
Lancet 2005;366:1607-1621.
Background
The combination of clopidogrel and aspirin in the setting of acute coronary syndromes without ST-segment elevation is proven to be beneficial. Whether the same effect occurs in myocardial infarction with ST-segment elevation is not well established.
Purpose
To determine the benefit of adding clopidogrel to aspirin in patients with myocardial infarction, with ST elevation or left-bundle branch block.
Design
Multicenter, randomized parallel-controlled trial in China 45 852 patients (no age limit) with acute myocardial infarction (ST segment elevation or new left bundle branch block) within 24 hours of symptom onset Patients undergoing primary percutaneous coronary intervention or deemed to be at high risk of bleeding were excluded.
Exclusion Criteria
None.
Follow-Up
Until hospital discharge or up to 4 weeks (mean: 16 days)
Treatment Regimen
Clopidogrel 75 mg once daily (no loading dose given) versus placebo Aspirin 162 mg daily in all patients
Results
Primary Endpoints: Death from any cause and the composite of death, reinfarction and stroke up to 4 weeks in hospital or prior to discharge. Both co-primary outcomes were significantly reduced with the addition of clopidogrel. Clopidogrel reduced the risk of reinfarction, but the effect on stroke reduction was not statistically significant. There was no difference in rate of major bleeding between the two groups, irregardless of patient age or use of fibrinolytic.
Summary
The addition of clopidogrel to aspirin in patients with acute ST-elevation myocardial infarction, in addition to other standard treatments (including fibrinolytic therapy) reduces the risk of all-cause death and the composite of death, reinfarction and stroke, without increasing major bleeding.
Implications
None.
Related Figures
[2]