Has the ClOpidogrel and Metoprolol in XXXX Trial (COMMIT) of early b-blocker use in @entity1187 impacted on clinical practice in Canada? Insights from the Global Registry of Acute Coronary Events (GRACE).

@entity1 @entity1187 @entity583 @entity1167
BACKGROUND: The COMMIT/CCS-2 trial, published in 2005, demonstrated no net benefit of early b-blocker (BB) therapy in @entity1187 ( @entity1187 ). We sought to assess the short-term impact of this landmark trial by comparing the use of early BB therapy in @entity1 with a broad spectrum of @entity1187 before and after 2005. METHODS: Using data from the Global Registry of Acute Coronary Events and Canadian Registry of Acute Coronary Events, we compared the rates of BB use within the first 24 hours of presentation in the periods 1999 to 2005 and 2006 to 2008, after stratifying @entity1 by the type of @entity1187 ( @entity583 [ @entity583 ] and non-ST-segment elevation @entity1187 [NSTEACS]) and clinical presentation. RESULTS: Of the 14,231 @entity1 with @entity1187 , 77.7% received BB therapy within 24 hours of presentation (78.5% and 77.4% in the @entity583 and NSTEACS groups, respectively). The early use of BB declined in the @entity583 group (80.3% to 76.7%, P = .005) but increased in the NSTEACS group (75.4% to 78.9%, P < .001) after 2005. Long-term BB use, higher systolic blood pressure, and higher heart rate were independent predictors of early BB use. Conversely, @entity1 who were female, older, Killip class >1, and had @entity1167 at presentation were less likely to receive early BB. Multivariable analysis showed a trend toward lower use of BB among @entity1 with @entity583 (adjusted odds ratio 0.76, 95% CI 0.57-1.00, P = .055) and a trend toward more frequent BB use among @entity1 with NSTEACS (adjusted odds ratio 1.22, 95% CI 0.96-1.55, P = .11) after 2005. The temporal trends in the early use of BB differed between @entity1 with @entity583 and @entity1 with NSTEACS (P for interaction with period <.001). CONCLUSIONS: Most @entity1 with @entity583 or NSTEACS were treated with early BB therapy. In accordance with the COMMMIT/CCS-2 trial, @entity1 with lower systolic blood pressure and higher Killip class in the "real world" less frequently received early BB therapy. Since the publication of COMMIT/CCS-2, there has been no significant change in the use of BB in @entity1 with @entity583 or NSTEACS after controlling for their clinical characteristics.
