COMMIT CCS-2研究课件.pptVIP

Perspective onCOMMIT/CCS-2 Trial of Metoprolol in STEMI First impression Wow !? I had predicted dramatic benefit with multiple 0’s in the P value Older B-blocker trials (up to 1986) 27,000 patients from 28 trials Meta-analysis: B-blocker (3.7%) Control (4.3%) 16% relative risk reduction 95% CI: 1-30% P=0.02 On re-looking: Lower risk patients studied Wide confidence intervals on mortality benefit Evolution of use of B-Blockers in AMI Benefits seen in meta-analysis of RCTs: reduced mortality, re-MI, VF, rec. ischemia Initially contraindicated if CHF Then, trials in outpatients with L