Addition of clopidogrel to aspirin, but not early use of metoprolol, improved overall outcome in acute myocardial infarction
Bibliographic record
Abstract
COMMIT Collaborative Group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366:1607–21.COMMIT Collaborative Group. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366:1622–32. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Q In patients hospitalised within 24 hours of suspected acute myocardial infarction (AMI), does the addition of clopidogrel to aspirin and the early use of metoprolol improve outcomes? Clinical impact ratings IM/Ambulatory care ★★★★★★★ Internal medicine ★★★★★★☆ Cardiology ★★★★★★★ Emergency medicine ★★★★★★☆ ### ![Graphic][5]</img>Design randomised placebo controlled trial with 2 × 2 factorial design (Clopidogrel and Metoprolol in Myocardial Infarction Trial [COMMIT]). ### ![Graphic][6]</img>Allocation concealed.* ### ![Graphic][7]</img>Blinding blinded {clinicians, patients, and outcome assessors}†.* ### ![Graphic][8]</img>Follow up period until first hospital discharge or 28 days. ### ![Graphic][9]</img>Setting 1250 hospitals in China. ### ![Graphic][10]</img>Patients 45 852 patients (mean age 61 y, 72% men) hospitalised within 24 hours (mean 10 h) of onset of symptoms of AMI, with ST elevation (87%), left bundle branch block (6%), or ST depression (7%) and no clear indication for or against the study medications. Those with moderate heart failure were eligible. Patients scheduled for primary percutaneous coronary intervention (PCI) and those with small likelihood of benefit or high risk for adverse effects were excluded. ### ![Graphic][11]</img>Interventions clopidogrel, 75 mg once daily (n = 22 961), or placebo (n = 22 891); all patients also received aspirin, 162 mg once daily. Intravenous (IV) metoprolol, 5 mg, up to 3 doses given over 2–3 minutes and spaced 2–3 minutes apart (provided heart rate >50 beats/min and systolic blood pressure >90 mm Hg), then oral metoprolol, 50 mg every 6 hours for 2 days, followed by oral controlled release metoprolol, 200 mg once daily (n = 22 929), or placebo (n = 22 923). 54% of patients also received fibrinolytic therapy. ### ![Graphic][12]</img>Outcomes clopidogrel study: composite end point (death, reinfarction, or stroke), all cause mortality, … [1]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DChen%26rft.auinit1%253DZ.%2BM.%26rft.volume%253D366%26rft.issue%253D9497%26rft.spage%253D1622%26rft.epage%253D1632%26rft.atitle%253DEarly%2Bintravenous%2Bthen%2Boral%2Bmetoprolol%2Bin%2B45%252C852%2Bpatients%2Bwith%2Bacute%2Bmyocardial%2Binfarction%253A%2Brandomised%2Bplacebo-controlled%2Btrial.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252805%252967661-1%26rft_id%253Dinfo%253Apmid%252F16271643%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0140-6736(05)67661-1&link_type=DOI [3]: /lookup/external-ref?access_num=16271643&link_type=MED&atom=%2Febmed%2F11%2F3%2F82.atom [4]: /lookup/external-ref?access_num=000233047100023&link_type=ISI [5]: /embed/inline-graphic-1.gif [6]: /embed/inline-graphic-2.gif [7]: /embed/inline-graphic-3.gif [8]: /embed/inline-graphic-4.gif [9]: /embed/inline-graphic-5.gif [10]: /embed/inline-graphic-6.gif [11]: /embed/inline-graphic-7.gif [12]: /embed/inline-graphic-8.gif
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Editorial About the Canadian research system: no · About a Canadian topic: no | Not applicable | high |
| gpt | no category Domain: not available · Genre: Commentary About the Canadian research system: no · About a Canadian topic: no | Observational | medium |
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".