COMET研究课件（PPT 7页）.ppt

COMET: Carvedilol Or Metoprolol European Trial Purpose To compare the effects of carvedilol (a β1-, β2- and α1-receptor blocker) and short-acting metoprolol tartrate (a β1-receptor blocker) on clinical outcome in patients with chronic heart failure Reference Poole-Wilson PA, Swedberg K, Cleland JGF et al. for the COMET Investigators. 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. Lancet 2003;362:7–13. COMET: Carvedilol Or Metoprolol European Trial- TRIAL DESIGN - Design Multicenter, multinational, randomized, double-blind, parallel group Patients 3029 patients in NYHA class II–IV, previously hospitalized for a cardiovascular reason, who had left ventricular ejection fraction 0.35 and were receiving optimal treatment with diuretics and ACE inhibitors unless not tolerated Follow up and primary endpoint Primary endpoint: all-cause mortality. Mean 4.8 years follow up. Treatment Short-acting metoprolol tartrate titrated to target dose 50 mg twice daily or carvedilol titrated to target dose 25 mg twice daily COMET: Carvedilol Or Metoprolol European Trial- TRIAL DESIGN continued- COMET: Carvedilol Or Metoprolol European Trial- RESULTS - All-cause mortality significantly reduced in carvedilol group compared with short-acting metoprolol tartrate (34 vs. 40%, P=0.0017) Cardiovascular mortality significantly reduced (29 vs. 35%, P=0.0004) No significant difference in composite secondary endpoint of all-cause mortality or admission (74 vs. 76%, hazard ratio 0.94, 95% CI 0.86–1.02, P=0.122): Withdrawal rate identical (32%) and incidence of adverse events similar (94 vs. 96%) in both treatment groups COMET: Carvedilol Or Metoprolol European Trial- RESULTS continued - COMET: Carvedilol Or Metoprolol European Trial- RESULTS continued - COMET: Carvedilol Or Metoprolol European Trial- SUMMARY - Compared with