File Download

There are no files associated with this item.

  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Rationale, design and organization of the Second Chinese Cardiac Study (CCS-2): A randomized trial of clopidogrel plus aspirin, and of metoprolol, among patients with suspected acute myocardial infarction

TitleRationale, design and organization of the Second Chinese Cardiac Study (CCS-2): A randomized trial of clopidogrel plus aspirin, and of metoprolol, among patients with suspected acute myocardial infarction
Authors
Issue Date2000
Citation
Journal Of Cardiovascular Risk, 2000, v. 7 n. 6, p. 435-441 How to Cite?
AbstractAssessing combined anti-platelet therapy in suspected acute myocardial infarction. Aspirin has been shown to be effective in the emergency treatment of acute myocardial infarction. It irreversibly inhibits platelet cyclo-oxygenase and thereby prevents the formation of the platelet aggregating agent thromboxane A 2. Clopidogrel is an anti-platelet agent that acts by a different mechanism, inhibiting adenosine diphosphate-induced platelet aggregation. Simultaneous inhibition of both of these pathways might produce significantly greater anti-platelet effects than inhibition of either alone. The Second Chinese Cardiac Study (CCS-2) will reliably determine whether adding oral clopidogrel to aspirin for up to 4 weeks in hospital after suspected acute myocardial infarction can produce a greater reduction in the risk of major vascular events than can be achieved by giving aspirin alone. In order to be able to detect a further reduction of 10-15%, some 20 000-40 000 patients in over 1000 Chinese hospitals will be randomized. Assessing early beta-blocker therapy in suspected acute myocardial infarction. Although over 27 000 patients have been studied previously in randomized trials of short-term beta-blocker therapy in acute myocardial infarction, the reduction in early mortality (513 (3.7%) for beta-blocker therapy deaths versus 586 (4.3%) for control deaths) was only just conventionally significant (P= 0.02) and, overall, the absolute benefits were small in the relatively low-risk patients studied. Although there might be worthwhile benefit in higher risk patients, there is currently little routine use of beta-blocker therapy in acute myocardial infarction. Hence, patients in CCS-2 will also be randomly allocated to receive metoprolol (intravenous then oral) or matching placebo for up to 4 weeks in hospital in a 2 × 2 factorial design. Such a design allows all patients to contribute fully to assessment of the separate effects of the anti-platelet regimen and the beta-blocker (without any material effect on study cost or sample size requirements) whilst also providing information about their combined effects. A streamlined trial in a wide range of patients. In order to randomize 20 000-40 000 patients, the design of CCS-2 has been streamlined: data collection and other extra work for collaborators is minimal, allowing busy hospitals to take part easily. All patients presenting within 24h of the onset of suspected acute myocardial infarction are eligible for the study provided they have a definite ECG abnormality and are not persistently hypotensive, and provided the doctor responsible considers there to be no clear indication for or contraindication to either of the trial treatments. Apart from administration of the trial treatments, all other aspects of individual patient management are entirely at the discretion of the doctor responsible. By including many different types of patient from many different types of hospital, with wide variation in ancillary management, the CCS-2 results will be of direct clinical relevance to the heterogeneous realities of future clinical practice. The trial began in July 1999 and is expected to be completed by the year 2003. © 2000 Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/151549
ISSN
2005 Impact Factor: 2.548
References

 

DC FieldValueLanguage
dc.contributor.authorLiu, LSen_US
dc.contributor.authorCollins, Ren_US
dc.contributor.authorChen, ZMen_US
dc.contributor.authorXie, JXen_US
dc.contributor.authorJiang, LXen_US
dc.contributor.authorWang, Wen_US
dc.contributor.authorPan, HCen_US
dc.contributor.authorPeto, Ren_US
dc.contributor.authorTao, SQen_US
dc.contributor.authorGong, LSen_US
dc.contributor.authorHui, RTen_US
dc.contributor.authorHuang, TGen_US
dc.contributor.authorZeng, DYen_US
dc.contributor.authorChen, YZen_US
dc.contributor.authorLiu, YHen_US
dc.contributor.authorQian, TJen_US
dc.contributor.authorXu, CBen_US
dc.contributor.authorDai, GZen_US
dc.contributor.authorFeng, JZen_US
dc.contributor.authorCai, NSen_US
dc.contributor.authorHu, DYen_US
dc.contributor.authorHuang, Jen_US
dc.contributor.authorLi, TDen_US
dc.contributor.authorLi, YQen_US
dc.contributor.authorWang, LHen_US
dc.contributor.authorYang, DCen_US
dc.contributor.authorZhu, Jen_US
dc.contributor.authorZhu, DQen_US
dc.contributor.authorZhou, JCen_US
dc.contributor.authorYang, XFen_US
dc.contributor.authorCui, JJen_US
dc.contributor.authorJiang, BQen_US
dc.contributor.authorYin, JQen_US
dc.contributor.authorSan, Jen_US
dc.contributor.authorHuang, DJen_US
dc.contributor.authorXi, WHen_US
dc.contributor.authorFu, SYen_US
dc.contributor.authorChen, YPen_US
dc.contributor.authorGent, Men_US
dc.contributor.authorSleight, Pen_US
dc.contributor.authorMacmahon, Sen_US
dc.contributor.authorSandercock, Pen_US
dc.contributor.authorLam, THen_US
dc.contributor.authorKong, XLen_US
dc.contributor.authorNie, QHen_US
dc.contributor.authorSchoepff, Hen_US
dc.contributor.authorBoreham, Jen_US
dc.contributor.authorLin, YYen_US
dc.contributor.authorChen, XQen_US
dc.contributor.authorXiao, GXen_US
dc.contributor.authorXu, SYen_US
dc.contributor.authorWang, JQen_US
dc.contributor.authorGuo, XZen_US
dc.date.accessioned2012-06-26T06:24:33Z-
dc.date.available2012-06-26T06:24:33Z-
dc.date.issued2000en_US
dc.identifier.citationJournal Of Cardiovascular Risk, 2000, v. 7 n. 6, p. 435-441en_US
dc.identifier.issn1350-6277en_US
dc.identifier.urihttp://hdl.handle.net/10722/151549-
dc.description.abstractAssessing combined anti-platelet therapy in suspected acute myocardial infarction. Aspirin has been shown to be effective in the emergency treatment of acute myocardial infarction. It irreversibly inhibits platelet cyclo-oxygenase and thereby prevents the formation of the platelet aggregating agent thromboxane A 2. Clopidogrel is an anti-platelet agent that acts by a different mechanism, inhibiting adenosine diphosphate-induced platelet aggregation. Simultaneous inhibition of both of these pathways might produce significantly greater anti-platelet effects than inhibition of either alone. The Second Chinese Cardiac Study (CCS-2) will reliably determine whether adding oral clopidogrel to aspirin for up to 4 weeks in hospital after suspected acute myocardial infarction can produce a greater reduction in the risk of major vascular events than can be achieved by giving aspirin alone. In order to be able to detect a further reduction of 10-15%, some 20 000-40 000 patients in over 1000 Chinese hospitals will be randomized. Assessing early beta-blocker therapy in suspected acute myocardial infarction. Although over 27 000 patients have been studied previously in randomized trials of short-term beta-blocker therapy in acute myocardial infarction, the reduction in early mortality (513 (3.7%) for beta-blocker therapy deaths versus 586 (4.3%) for control deaths) was only just conventionally significant (P= 0.02) and, overall, the absolute benefits were small in the relatively low-risk patients studied. Although there might be worthwhile benefit in higher risk patients, there is currently little routine use of beta-blocker therapy in acute myocardial infarction. Hence, patients in CCS-2 will also be randomly allocated to receive metoprolol (intravenous then oral) or matching placebo for up to 4 weeks in hospital in a 2 × 2 factorial design. Such a design allows all patients to contribute fully to assessment of the separate effects of the anti-platelet regimen and the beta-blocker (without any material effect on study cost or sample size requirements) whilst also providing information about their combined effects. A streamlined trial in a wide range of patients. In order to randomize 20 000-40 000 patients, the design of CCS-2 has been streamlined: data collection and other extra work for collaborators is minimal, allowing busy hospitals to take part easily. All patients presenting within 24h of the onset of suspected acute myocardial infarction are eligible for the study provided they have a definite ECG abnormality and are not persistently hypotensive, and provided the doctor responsible considers there to be no clear indication for or contraindication to either of the trial treatments. Apart from administration of the trial treatments, all other aspects of individual patient management are entirely at the discretion of the doctor responsible. By including many different types of patient from many different types of hospital, with wide variation in ancillary management, the CCS-2 results will be of direct clinical relevance to the heterogeneous realities of future clinical practice. The trial began in July 1999 and is expected to be completed by the year 2003. © 2000 Lippincott Williams & Wilkins.en_US
dc.languageengen_US
dc.relation.ispartofJournal of Cardiovascular Risken_US
dc.subject.meshAdrenergic Beta-Antagonists - Therapeutic Useen_US
dc.subject.meshAnti-Inflammatory Agents, Non-Steroidal - Therapeutic Useen_US
dc.subject.meshAspirin - Therapeutic Useen_US
dc.subject.meshChinaen_US
dc.subject.meshDrug Therapy, Combinationen_US
dc.subject.meshHumansen_US
dc.subject.meshMetoprolol - Therapeutic Useen_US
dc.subject.meshMyocardial Infarction - Drug Therapyen_US
dc.subject.meshPlatelet Aggregation Inhibitors - Therapeutic Useen_US
dc.subject.meshResearch Designen_US
dc.subject.meshTiclopidine - Analogs & Derivatives - Therapeutic Useen_US
dc.titleRationale, design and organization of the Second Chinese Cardiac Study (CCS-2): A randomized trial of clopidogrel plus aspirin, and of metoprolol, among patients with suspected acute myocardial infarctionen_US
dc.typeArticleen_US
dc.identifier.emailLam, TH:hrmrlth@hkucc.hku.hken_US
dc.identifier.authorityLam, TH=rp00326en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid11189013-
dc.identifier.scopuseid_2-s2.0-0034533996en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0034533996&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume7en_US
dc.identifier.issue6en_US
dc.identifier.spage435en_US
dc.identifier.epage441en_US
dc.identifier.scopusauthoridLiu, LS=7405259104en_US
dc.identifier.scopusauthoridCollins, R=7403350771en_US
dc.identifier.scopusauthoridChen, ZM=7409483946en_US
dc.identifier.scopusauthoridXie, JX=7402994954en_US
dc.identifier.scopusauthoridJiang, LX=35310643700en_US
dc.identifier.scopusauthoridWang, W=8423280400en_US
dc.identifier.scopusauthoridPan, HC=55007350300en_US
dc.identifier.scopusauthoridPeto, R=7102951835en_US
dc.identifier.scopusauthoridTao, SQ=7202041922en_US
dc.identifier.scopusauthoridGong, LS=7202769796en_US
dc.identifier.scopusauthoridHui, RT=7006029377en_US
dc.identifier.scopusauthoridHuang, TG=8885402700en_US
dc.identifier.scopusauthoridZeng, DY=7102695300en_US
dc.identifier.scopusauthoridChen, YZ=35357102200en_US
dc.identifier.scopusauthoridLiu, YH=36068301400en_US
dc.identifier.scopusauthoridQian, TJ=35852547200en_US
dc.identifier.scopusauthoridXu, CB=7404182279en_US
dc.identifier.scopusauthoridDai, GZ=19642445700en_US
dc.identifier.scopusauthoridFeng, JZ=7403884010en_US
dc.identifier.scopusauthoridCai, NS=7007040687en_US
dc.identifier.scopusauthoridHu, DY=7402585148en_US
dc.identifier.scopusauthoridHuang, J=18334794700en_US
dc.identifier.scopusauthoridLi, TD=36150870700en_US
dc.identifier.scopusauthoridLi, YQ=19735881100en_US
dc.identifier.scopusauthoridWang, LH=35486061400en_US
dc.identifier.scopusauthoridYang, DC=16417892900en_US
dc.identifier.scopusauthoridZhu, J=7405692054en_US
dc.identifier.scopusauthoridZhu, DQ=19740277800en_US
dc.identifier.scopusauthoridZhou, JC=35228239600en_US
dc.identifier.scopusauthoridYang, XF=7408600779en_US
dc.identifier.scopusauthoridCui, JJ=7401811229en_US
dc.identifier.scopusauthoridJiang, BQ=26659611600en_US
dc.identifier.scopusauthoridYin, JQ=19740116500en_US
dc.identifier.scopusauthoridSan, J=7003902901en_US
dc.identifier.scopusauthoridHuang, DJ=55238648000en_US
dc.identifier.scopusauthoridXi, WH=7006703323en_US
dc.identifier.scopusauthoridFu, SY=19733540300en_US
dc.identifier.scopusauthoridChen, YP=36050189600en_US
dc.identifier.scopusauthoridGent, M=7102766719en_US
dc.identifier.scopusauthoridSleight, P=7102062009en_US
dc.identifier.scopusauthoridMacMahon, S=24312201200en_US
dc.identifier.scopusauthoridSandercock, P=7102712686en_US
dc.identifier.scopusauthoridLam, TH=7202522876en_US
dc.identifier.scopusauthoridKong, XL=55118065900en_US
dc.identifier.scopusauthoridNie, QH=7005041776en_US
dc.identifier.scopusauthoridSchoepff, H=6507592070en_US
dc.identifier.scopusauthoridBoreham, J=24538571000en_US
dc.identifier.scopusauthoridLin, YY=19736063500en_US
dc.identifier.scopusauthoridChen, XQ=15032046900en_US
dc.identifier.scopusauthoridXiao, GX=19740170500en_US
dc.identifier.scopusauthoridXu, SY=37070097500en_US
dc.identifier.scopusauthoridWang, JQ=7701317700en_US
dc.identifier.scopusauthoridGuo, XZ=16552167700en_US

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats