COMMIT/CCS-2:
ClOpidogrel & Metoprolol
in Myocardial Infarction Trial
Beijing (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)
Guizhou (11)
Hainan (7)
Sichuan (49)
Yunnan (12)
Shaanxi (43)
Gansu (25)
Qinghai (4)
Nei Mongol (38)
Guangxi (30)
Ningxia (8)
Xinjiang (7)
Chongqing (11)
COMMIT: 45,852 patients from
1250 centres in China
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: Study design
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: Baseline characteristics
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: Concomitant therapy
COMMIT: Effects of CLOPIDOGREL on Death, Re-MI or Stroke
Days since randomisation (up to 28 days)
Event (%)
9% (SE3) relative risk
reduction (2P=0.002)
Placebo + ASA:
2311 events (10.1%)
Clopidogrel + ASA:
2125 events (9.3%)
COMMIT: Effect of CLOPIDOGREL on Death in hospital
Dead
(%)
Days since randomisation (up to 28 days)
Placebo + ASA:
1846 deaths (8.1%)
Clopidogrel +ASA:
1728 deaths (7.5%)
7% (SE3) relative risk
reduction (2P=0.03)
COMMIT: Effects of CLOPIDOGREL
on Reinfarction
Clopidogrel
Placebo
Odds ratio & 95% CI
Clopid. better
Placebo better
Outcome
after Re-MI
(22,958)
(22,891)
Died
209
223
(0.9%)
(1.0%)
Survived
273
330
(1.2%)
(1.4%)
ALL COMBINED
482
553
(2.1%)
(2.4%)
13% SE 6
(2P = 0.02)
0.4
0.6
0.8
1.0
1.2
1.4
1.6
COMMIT: Effects of CLOPIDOGREL
on any Stroke
Clopidogrel
Placebo
Odds ratio & 95% CI
Clopid. better
Placebo better
Types
(22,958)
(22,891)
Ischaemic
162
192
(0.7%)
(0.8%)
Haemorrhagic
55
55
(0.2%)
(0.2%)
ALL COMBINED
216
249
(0.9%)
(1.1%)
14% SE 9
(2P > 0.1; NS)
0.4
0.6
0.8
1.0
1.2
1.4
1.6
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%)
COMMIT: Major bleed in hospital
COMMIT: Effects of CLOPIDOGREL on
Death, Re-MI or Stroke by day of event
Clopidogrel
Placebo
Odds ratio & 95% CI
Clopid. better
Placebo better
Day of event
(22,958)
(22,891)
0
463
523
(2.0%)
(2.3%)
1
486
527
(2.1%)
(2.3%)
2-3
449
451
(2.0%)
(2.0%)
4-7
432
463
(1.9%)
(2.0%)
8-28
295
347
(1.3%)
(1.5%)
ALL
2125
2311
(9.3%)
(10.1%)
9% SE 3
(2P = 0.002)
0.4
0.6
0.8
1.0
1.2
1.4
1.6
COMMIT: Effects of CLOPIDOGREL on
Death, Re-MI or Stroke by sex and age
Clopidogrel
Placebo
Odds ratio & 95% CI
Clopid. better
Placebo better
Baseline
features
(22,958)
(22,891)
Sex
Male
1276
1416
(7.7%)
(8.6%)
Female
849
895
(13.3%)
(14.0%)
Age (years)
<60
487
513
(5.1%)
(5.4%)
60-69
747
835
(10.2%)
(11.2%)
70+
891
963
(14.9%)
(16.2%)
ALL
2125
2311
(9.3%)
(1