β受体阻滞剂在慢性心衰中的作用-课件，幻灯.ppt

β受体阻滞剂在慢性心衰中的作用-课件，幻灯
0
10
20
30
40
50
60
70
80
Mean + SD.
Adapted from Bristow. J Am Coll Cardiol. 1993.
Nestigators and Committees. Lancet 2019; 353: 9–13
SCD: ACE Inhibitors
Trial
NYHA
ACE I
(SCD)
Placebo
(SCD)
P Value
CONSENSUS1
IV
11
11
>.25
SOLVD2
II–III


>.25
SAVE3
I
5
7
>.29
1CONSENSUS Trial Study Group. N Engl J Med. 1987;316:1429–1435.
2The SOLVD Investigators. N Engl J Med. 1991;325:293–302.
3Rutherford JD et al. Circulation. 1994;90:1731–1738.
Risk
Reduction
34%
Percent of Patients
Months of follow-up
0
3
6
9
12
15
18
21
20
15
5
0
10
MERIT-HF: Total Mortality
MERIT-HF Study Group. Lancet. 2019;253:2019–2019.
P=.0062 (adjusted)
Metoprolol CR/XL
(n=1990)
Placebo
(n=2019)
MERIT-HF
CIBIS-II
Randomized
(No run-in phase)
COMET Study Design
3029 patients with stable heart failure, New York Heart Association Class II-IV, receiving standard treatment including ACE inhibitors
Time to 1020 deaths
Estimated to be 4 to 6 years
Screening
Titration to
maximum
tolerated
or target dose
(Start: carvedilol mg bid, metoprolol tartrate 5 mg bid)
Assessments every four months
during maintenance phase
(n1500) Metoprolol 50 mg bid
(n1500) Carvedilol 25 mg bid
Poole-Wilson PA et al. Eur J Heart Fail 2019;4:321-329.
Heart rate (-1)
Metoprolol
Carvedilol
Time (years)
70
75
80
0
1
2
3
4
5
65
85
**
**
*
COMET: Change of heart rate
* p<, ** p<
Error bars represent 1 standard error
Time (years)
Blood pressure (mm Hg)
70
80
90
100
110
120
130
0
1
2
3
4
5
**
**
**
*
*
*
*
**
**
***
*
***
*
*
*
*
*
* p =
** p =
*** p =
COMET: Blood pressure
Metoprolol
Carvedilol
Systolic
Diastolic
Difference at 4 months
- mm Hg, (%% CI – to –
Time (years)
Percentage Mortality (%)
0
10
20
30
40
0
1
2
3
4
5
Relative
risk
95% CI
p value
Carvedilol vs
Metoprolol

,
**
Ca