About 10 million human frames worl...

About 10 million human frames worldwide have acute myocardial infarction (MI) each year. Despite improvements in immediate care, the rates of mortality and morbidity remain high, prompting interest in simple early interventions that could diminish the effects of this condition. The COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) application of mind focused on early administration of the antiplatelet put drugs into clopidogrel (Plavix) plus aspirin in myocardial infarction.

The randomized, placebo-controlled trial recruited more than 45000 Chinese patients presenting with S-T elevation or depression, or left pack branch block within 24 hours of storm of acute symptoms of MI. Patients who had no contraindications to the cogitation medications were randomly assigned to immediate treatment with 162 mg aspirin plus 75 mg clopidogrel or an identical placebo. Patients then received the same brace pills every day for four weeks in addition to whatever therapy was thinked appropriate by the attending physicians. All additional antiplatelet therapy was avoided unles a healthy indication developed for its use. Patients were reassessed at day 28 or onward hospital discharge for occurrence of major clinical consequences death and cause of death, compliance with application of mind medications, possible adverse effects, and use of additional treatments. The primary issues measured were all-cause mortality and the composite of death, reinfarction, or stroke

The 22961 patients assigned to aspirin plus clopidogrel were comparable with the 22891 assigned to aspirin plus placebo in all significant variables. The mean age was 61 years, and the mean time from symptom attack to treatment was 10 hours. Eight percent of participants had a previous MI, and 43 percent had hypertension. Before this conclusion 18 percent had used aspirin. individual half of the study participants received fibrinolytic therapy before randomization. The mean duration of treatment was 149 days in the pair groups. The two groups did not differ significantly in participants' reasons for discontinuing therapy.

the pair primary outcomes showed significant reduction in the aspirin plus clopidogrel cluster The 1,726 deaths (7.5 percent) in the clopidogrel assign places to were significantly lower than the 1845 deaths (81 percent) in the placebo cluster For the combined outcome of death, reinfarction, and hardship the 2,121 events (9.2 percent) in the clopidogrel arrange were significantly less than the 2310 marked occurrences (10.1 percent) in the regulate group. No differences were recorded between the assign places tos in other major outcomes (i.e., heart failure, cardiogenic impact presumed cardiac rupture, ventricular fibrillation, other cardiac arrest, pulmonary embolism). No significant differences occurr in the incidence of major bleeding complications (058 percent for clopidogrel compared with 055 percent for placebo), moreover patients in the clopidogrel cluster had a small but significant increase in minor bleeding complications. The minor bleeding conclusions were mainly oral and skin bleeding and amounted to an exces of 47 marked occurrences per 1,000 patients. Overall, about brace weeks of clopidogrel therapy was associated with a savings of nine circumstances (death, reinfarction, or stroke) through 1,000 patients.

The authors determine that clopidogrel should be considered for all cases of suspected acute MI if there are no contraindications. They argue that the savings throughout the longer term could be abundant greater.

ANNE D WALLING, MD

COMMIT collaborative clump Addition of clopidogrel to aspirin in 45852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet November 5 2005;366:1607-21

COPYRIGHT 2006 American Academy of Family Physicians

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