Mrdovic Igor Bogdan, Savic Lidija Zlatimir, Perunicic Jovan Petar, Asanin Milika Risto, Lasica Ratko Milorad, Jelena Marinkovic Milutin, Matic Mihailo Dragomir, Vasiljevic Zorana Mihailo, Ostojic Miodrag Caslav
Institute for Cardiovascular Diseases, Emergency Hospital, Clinical Centre of Serbia, Belgrade, Serbia.
Am Heart J. 2007 Jul;154(1):116-22. doi: 10.1016/j.ahj.2007.03.049.
Carvedilol has previously been demonstrated to be beneficial in patients with acute myocardial infarction (AMI) and left ventricular (LV) dysfunction. However, metoprolol has not to date been randomly evaluated in the same patient population. The objective of this study was to compare the effects of treatment with carvedilol versus metoprolol in patients with LV dysfunction after AMI.
The study enrolled 313 high-risk patients with anterior AMI and LV ejection fraction of <45%, randomly assigned to treatment with carvedilol or metoprolol. Patients were followed-up for a mean period of 13.4 months. The primary end point was time to composite adverse events (t-CAE). The secondary end points were time to composite hard events (t-CHE) and health-related quality of life.
No differences were found either in the primary end point of t-CAE or in the secondary end point of t-CHE. A significant benefit was observed in 4 of 8 health-related quality of life domains in the carvedilol group, with fewer carvedilol group patients being withdrawn from therapy in the hospital.
Treatment with carvedilol, in comparison to that with metoprolol in patients with AMI and LV dysfunction, did not differ significantly in regard to the primary end point of t-CAE or to the secondary end point of t-CHE but resulted in better long-term quality of life and favorable early safety profile.
此前已证明卡维地洛对急性心肌梗死（AMI）和左心室（LV）功能不全患者有益。然而，美托洛尔迄今尚未在同一患者群体中进行随机评估。本研究的目的是比较卡维地洛与美托洛尔对AMI后LV功能不全患者的治疗效果。
该研究纳入了313例高危前壁AMI且左室射血分数<45%的患者，随机分配接受卡维地洛或美托洛尔治疗。患者平均随访13.4个月。主要终点是复合不良事件发生时间（t-CAE）。次要终点是复合严重事件发生时间（t-CHE）和健康相关生活质量。
在t-CAE主要终点或t-CHE次要终点方面均未发现差异。在卡维地洛组的8个健康相关生活质量领域中有4个观察到显著益处，卡维地洛组在医院退出治疗的患者较少。
与美托洛尔相比，卡维地洛治疗AMI和LV功能不全患者时，在t-CAE主要终点或t-CHE次要终点方面无显著差异，但能带来更好的长期生活质量和良好的早期安全性。
