1 / 15

COMMIT/CCS-2 ( C l O pidogrel & M etoprolol in M yocardial I nfarction T rial)

COMMIT/CCS-2 ( C l O pidogrel & M etoprolol in M yocardial I nfarction T rial). Designed, conducted, analysed and interpreted independently by COMMIT/CCS-2 collaboration Sources of funding (US$ 3M): SanofiAventis/BMS AstraZeneca British Heart Foundation UK Medical Research Council.

monet
Télécharger la présentation

COMMIT/CCS-2 ( C l O pidogrel & M etoprolol in M yocardial I nfarction T rial)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. COMMIT/CCS-2(ClOpidogrel & Metoprolol in MyocardialInfarction Trial) • Designed, conducted, analysed and interpreted independently by COMMIT/CCS-2 collaboration • Sources of funding (US$ 3M): • SanofiAventis/BMS • AstraZeneca • British Heart Foundation • UK Medical Research Council

  2. COMMIT: Study design • TREATMENT: Metoprolol 15 mg iv over 15 mins, then 200 mg oral daily vs matching placebo • INCLUSION: Suspected acute MI (ST change orLBBB) within 24 h of symptom onset • EXCLUSION: Shock, systolic BP <100 mmHg, heart rate <50/min or II/III AV block • 1 OUTCOMES: Death & death, re-MI or VF/arrest up to 4 weeks in hospital (or prior discharge) • Mean treatment and follow-up: 16 days

  3. COMMIT: Baseline characteristics • Characteristic Metoprolol Placebo (n=22,928) (n=22,923) • Aged 70+ 26.1% 26.0% • Time delay <6 h 34.0% 33.5% • SBP <120 mmHg 33.7% 33.5% • Anterior infarct 49.8% 49.6% • Killip class II 20.0% 19.8% • III 4.1% 4.2% • Fibrinolytic given 49.8% 49.7%

  4. COMMIT: Treatment compliance • Compliance Metoprolol Placebo • (n=22,927) (n=22,923) • First iv dose given 98.5% 98.6% • 3 iv doses completed 90.2% 96.0% • Oral treatment completed 86.2% 91.6%

  5. COMMIT: Effects of METOPROLOL on Reinfarction Outcome Metoprolol Placebo Odds ratio & 95% CI after Re-MI (22,927) (22,922) Metop. better Placebo better Died 206 (0.9%) 226 (1.0%) Survived 261 (1.1%) 342 (1.5%) 18% SE 6 ALL COMBINED 467 (2.0%) 568 (2.5%) (2P = 0.002) 0.4 0.7 1.0 1.3 1.6 1.9

  6. Effects of iv then oral -blockeron reinfarction in 3 major trials of acute MI Trial ß-blocker Control Odds ratio & 95% CI (33,841) (33,813) ß-blocker better Control better MIAMI 85 (3.0%) 111 (3.8%) ISIS-1 148 (1.8%) 161 (2.0%) COMMIT 467 (2.0%) 568 (2.5%) 17% SE 5 OVERALL 700 (2.1%) 840 (2.5%) (2P = 0.0003) 0.4 0.6 0.8 1.0 1.2 1.4 1.6

  7. COMMIT: Effects of METOPROLOL on Cardiac Arrest Events Metoprolol Placebo Odds ratio & 95% CI (22,927) (22,922) Metop. better Placebo better VF 582 (2.5%) 699 (3.0%) 17% SE 5 Other arrest 882 (3.8%) 899 (3.9%) 2% SE 5 5% SE 4 ANY OF ABOVE 1267 (5.5%) 1332 (5.8%) (2P > 0.1; NS) 0.4 0.7 1.0 1.3 1.6 1.9

  8. COMMIT: Effects of METOPROLOL on Death in hospital Placebo: 1798 deaths (7.8%) Metoprolol: 1776 deaths (7.7%) 1% (SE 3) relative risk reduction (2P=0.7) % dead Days since randomisation

  9. COMMIT: Effects of METOPROLOL on Death by attributed cause(s) Cause(s) Metoprolol Placebo Odds ratio & 95% CI (22,927) (22,922) Metop. better Placebo better Arrhythmia 388 (1.7%) 498 (2.2%) 22% SE 6 Shock 496 (2.2%) 384 (1.7%) -29% SE 8 Other causes 892 (3.9%) 916 (4.0%) 3% SE 5 1% SE 3 ANY DEATH 1776 (7.7%) 1798 (7.8%) (2P > 0.1; NS) 0.4 0.7 1.0 1.3 1.6 1.9

  10. COMMIT: Effects of METOPROLOL on CardiogenicShock by day of event Day of event Metoprolol Placebo Odds ratio & 95% CI (22,927) (22,922) Metop. better Placebo better 0 475 (2.1%) 317 (1.4%) 1 282 (1.2%) 210 (0.9%) 2+ 384 (1.7%) 361 (1.6%) -29% SE 5 ALL 1141 (5.0%) 888 (3.9%) (2P < 0.00001) 0.4 0.7 1.0 1.3 1.6 1.9

  11. COMMIT: Effects of METOPROLOL on CardiogenicShock by Killip class Baseline Metoprolol Placebo Odds ratio & 95% CI Killip class (22,927) (22,922) Metop. better Placebo better I 611 (3.5%) 487 (2.8%) II 362 (7.9%) 296 (6.5%) III 155 (16.2%) 100 (10.4%) -29% SE 5 ALL 1141 (5.0%) 888 (3.9%) (2P < 0.00001) 0.4 0.7 1.0 1.3 1.6 1.9

  12. COMMIT: Absolute effects of METOPROLOL on Re-MI, VF, Shock and Death by KILLIP class

  13. COMMIT: Effects of METOPROLOL on Death, Re-MIor Arrest by prognosis & fibrinolytic Baseline Metoprolol Placebo Odds ratio & 95% CI features (22,927) (22,922) Metop. better Placebo better Prognostic index Good 248 (3.3%) 284 (3.7%) Average 575 (7.5%) 642 (8.4%) Poor 1350 (17.6%) 1338 (17.5%) Lytic given Yes 1031 (9.0%) 1137 (10.0%) No 1142 (9.9%) 1127 (9.8%) 4% SE 3 ALL 2173 (9.5%) 2264 (9.9%) (2P > 0.1; NS) 0.4 0.6 0.8 1.0 1.2 1.4 1.6

  14. COMMIT: Effects of METOPROLOL on Deathby shock index Shock Metoprolol Placebo Odds ratio & 95% CI index (22,927) (22,922) Metop. better Placebo better Good 654 (4.1%) 719 (4.5%) Average 569 (12.1%) 598 (12.6%) Poor 553 (25.9%) 481 (23.4%) 1% SE 3 ALL 1776 (7.7%) 1798 (7.8%) (2P > 0.1; NS) 0.4 0.7 1.0 1.3 1.6

  15. COMMIT: Conclusions • Metoprolol (15 mg iv, then 200 mg oral daily) in acute MI did not significantly reduce mortality in hospital •  It reduced the absolute risks of reinfarction by 5 per 1000 (P=0.001) and of VF by 5 per 1000 (P<0.001) •  But, overall, it increased the risk of cardiogenic shock by 11 per 1000 (P<0.00001), chiefly on days 0-1 • In acute MI, it may be better to start beta-blocker when the patient is stable (and then continue long-term) • Slides available on: www.commit-ccs2.org

More Related