Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol, European Trial (COMET): randomised controlled trial

被引:1311
作者
Poole-Wilson, PA [1 ]
Swedberg, K
Cleland, JGF
Di Lenarda, A
Hanrath, P
Komajda, M
Lubsen, J
Lutiger, E
Metra, M
Remme, WJ
Torp-Pedersen, C
Scherhag, A
Skene, A
机构
[1] Univ London Imperial Coll Sci Technol & Med, Fac Med, Natl Heart & Lung Inst, London SW3 6LY, England
[2] Sahlgrenska Univ Hosp Ostra, Dept Med, Gothenburg, Sweden
[3] Univ Hull, Dept Cardiol, Kingston Upon Hull, Yorks, England
[4] Osped Cattinara, Dept Cardiol, Trieste, Italy
[5] Univ Hosp, Med Klin 1, Aachen, Germany
[6] Hop La Pitie Salpetriere, Dept Cardiol, Paris, France
[7] SOCAR Res SA, Nyon, Switzerland
[8] F Hoffmann La Roche & Co Ltd, Rotterdam, Netherlands
[9] Univ Brescia, Cattedra Cardiol, I-25121 Brescia, Italy
[10] Sticares Cardiovasc Res Fdn, Rhoon, Netherlands
[11] Bispebjerg Univ Hosp, Dept Cardiol, Copenhagen, Denmark
[12] Nottingham Clin Res Grp, Nottingham, England
关键词
IDIOPATHIC DILATED CARDIOMYOPATHY; INTERVENTION TRIAL; MERIT-HF; BETA-BLOCKERS; MORTALITY; BISOPROLOL; MORBIDITY; BLOCKADE; DESIGN; CR/XL;
D O I
10.1016/S0140-6736(03)13800-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background beta blockers reduce mortality in patients who have chronic heart failure, systolic dysfunction, and are on background treatment with diuretics and angiotensin-converting enzyme inhibitors. We aimed to compare the effects of carvedilol and metoprolol on clinical outcome. Methods In a multicentre, double-blind, and randomised parallel group trial, we assigned 1511 patients with chronic heart failure to treatment with carvedilol (target dose 25 mg twice daily) and 1518 to metoprolol (metoprolol tartrate, target dose 50 mg twice daily). Patients were required to have chronic heart failure (NYHA II-IV), previous admission for a cardiovascular reason, an ejection fraction of less than 0.35, and to have been treated optimally with diuretics and angiotensin-converting enzyme inhibitors unless not tolerated. The primary endpoints were all-cause mortality and the composite endpoint of all-cause mortality or all-cause admission. Analysis was done by intention to treat. Findings The mean study duration was 58 months (SD 6). The mean ejection fraction was 0.26 (0.07) and the mean age 62 years (11). The all-cause mortality was 34% (512 of 1511) for carvedilol and 40% (600 of 1518) for metoprolol (hazard ratio 0.83 [95% CI 0.74-0.93], p=0.0017). The reduction of all-cause mortality was consistent across predefined subgroups. The composite endpoint of mortality or all-cause admission occurred in 1116 (74%) of 1511 on carvedilol and in 1160 (76%) of 1518 on metoprolol (0.94 [0.86-1.02], p=0.122). Incidence of side-effects and drug withdrawals did not differ by much between the two study groups. Interpretation Our results suggest that carvedilol extends survival compared with metoprolol.
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页码:7 / 13
页数:7
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