COMMIT研究-氯吡格雷美托洛尔心肌梗死试验课件.ppt

TREATMENT: Clopidogrel 75 mg daily vs placebo (aspirin 162mg daily in both groups) INCLUSION: Suspected acute MI (ST change or LBBB) within 24 h of symptom onset EXCLUSION: Primary PCI or high-risk of bleeding 1? OUTCOMES: Death death, re-MI or stroke up to 4 weeks in hospital (or prior discharge) Mean treatment and follow-up: 16 days COMMIT: Baseline characteristics Characteristic Clopidogrel Placebo (n=22,960) (n=22,891) Age 70+ y 26.0% 26.0% Female 27.7% 27.9% Time delay 6 h 33.8% 33.7% STEMI/LBBB 93.1% 93.1% Killip class II/III 24.1% 24.0% Fibrinolytic: All patients 49.7% 49.8% STEMI 12h 67.8% 67.7% COMMIT: Concomitant therapy Therapy Clopidogrel Placebo (n=22,958) (n=22,891) Anticoagulants 74.1% 75.0% ACE inhibitors 68.2% 68.3% Anti-arrhythmics 22.4% 22.2% Nitrates 94.1% 94.3% Diuretics 23.3% 23.3% Calcium antagonists 11.8% 11.8% COMMIT: Major bleed in hospital Type Clopidogrel Placebo (n=22,958) (n=22,891) Cerebral Fatal 39 40 Non-fatal 16 15 Non-cerebral Fatal 36 37 Non-fatal 46 36 Any major bleed 134 124 (0.58%) (0.54%) From ISIS-2 to COMMIT: Effects of aspirin and clopidogrel on Death, Re-MI or Stroke ISIS-2: Placebo 14% ASA 10% COMMIT: ASA 10% ASA + Clop. 9% ASA + Clopidogrel vs nil: ~50 per 1000 treated COMMIT: Conclusions ? Adding 75 mg daily CLOPIDOGREL to aspirin in acute MI prevents ~10 major vascular events per 1000 treated ? No excess of cerebral,