COMMIT

Trial Details:

Acronym: ClOpidogrel and Metoprolol in Myocardial Infarction Trial 

Purpose: To evaluate the addition of metoprolol (beta-blocker) OR clopidogrel in acute coronary syndromes

Format: Double blind, multicenter, randomized control trial

Treatment Group: Metoprolol and/or clopidogrel

Control Group: Placebo

Number of Patients: 45,852

Follow-up: 28 days

Inclusion Criteria: ST elevation, left bundle branch block (LBBB) or ST depression on ECG within 24 hours of suspected symptoms of acute coronary syndrome

Exclusion Criteria:

• Patients undergoing PCI (since clopidogrel would have to be used in this group)
• Serious illness (i.e. metastatic cancer)
• Systolic blood pressure < 100 mmHg or heart rate < 50 BPM

Primary Endpoints:

• Composite of death, reinfarction, or cardiac arrest
• Death from any cause

Secondary Endpoint:

• Reinfarction
• Ventricular fibrilation
• Cardiac arrest
• Cardiogenic shock

Summary:

The addition of clopidogrel to aspirin during acute coronary syndromes reduced death, stroke and reinfarction. There was no difference in major bleeding.

Beta-blocker versus placebo as initial therapy in acute coronary syndromes. There was no difference in the composite endpoint of death, infarction and cardiac arrest. Beta-blockers decreased in reinfarction and ventricular fibrillation arrest. Beta-blockers increased risk of cardiogenic shock.

Original Publications:

Chen ZM, et al. Lancet. 2005;doi:10.1016/S0140-6736(05)67660-X
Chen ZM, et al. Lancet. 2005;doi:10.1016/S0140-6736(05)67661-1