Document Detail


Effects of metoprolol and carvedilol on cause-specific mortality and morbidity in patients with chronic heart failure--COMET.
MedLine Citation:
PMID:  15846279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Beta-blockers with different receptor bindings reduce mortality in patients with chronic heart failure. We compared the effects of the beta1-blocker metoprolol tartrate and the beta1-, beta2-, and alpha1-blocker carvedilol.
METHODS: In a randomized double-blind design, 3029 patients with chronic congestive heart failure requiring diuretic therapy and with left ventricular dysfunction were randomized to treatment with carvedilol (n = 1511) or metoprolol tartrate (n = 1518) and titrated to target doses of 25 mg of carvedilol twice daily or 50 mg of metoprolol tartrate twice daily. The main outcome measures were total mortality and the combination of mortality or hospitalization for any cause. Secondary end points were cardiovascular death, combinations of morbidity and mortality, New York Heart Association class, worsening of heart failure, hospitalizations, and discontinuation of study therapy.
RESULTS: A total of 512 and 600 patients in the carvedilol group and metoprolol group, respectively, died (hazard ratio [HR] 0.83, 95% CI 0.74-0.93, P = .0017). Cardiovascular death was reduced by carvedilol (HR 0.80, 95% CI 0.70-0.90, P = .0004). There were fewer sudden deaths and deaths caused by circulatory failure or by stroke in the carvedilol group. There was no difference in all-cause hospitalizations or in worsening heart failure between treatment groups. The incidence of fatal or nonfatal acute myocardial infarction was significantly lower in the carvedilol group (HR 0.71, 95% CI 0.52-0.97, P = .03). Discontinuations of study therapy were similar in the 2 groups.
CONCLUSION: Compared with metoprolol tartrate, carvedilol reduced cardiovascular mortality, sudden death, death caused by circulatory failure, death caused by stroke, as well as fatal and nonfatal myocardial infarctions.
Authors:
Christian Torp-Pedersen; Philip A Poole-Wilson; Karl Swedberg; John G F Cleland; Andrea Di Lenarda; Peter Hanrath; Michel Komajda; Beatrix Lutiger; Marco Metra; Willem J Remme; Armin Scherhag; Allan Skene;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  149     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-04-22     Completed Date:  2005-09-22     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  370-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. ctp@heart.dk
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use*
Carbazoles / therapeutic use*
Death, Sudden, Cardiac / etiology,  prevention & control
Double-Blind Method
Female
Heart Failure / complications,  drug therapy*,  mortality
Hospitalization
Humans
Male
Metoprolol / therapeutic use*
Middle Aged
Myocardial Infarction / epidemiology,  etiology,  prevention & control
Propanolamines / therapeutic use*
Survival Analysis
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Carbazoles; 0/Propanolamines; 0K47UL67F2/carvedilol; 37350-58-6/Metoprolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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