卡维地洛与琥珀酸美托洛尔治疗稳定型慢性心力衰竭患者的疗效及预后比较：卡维地洛或美托洛尔评估研究
Carvedilol Compared With Metoprolol Succinate in the Treatment and Prognosis of Patients With Stable Chronic Heart Failure: Carvedilol or Metoprolol Evaluation Study.
作者信息
Fröhlich Hanna, Zhao Jingting, Täger Tobias, Cebola Rita, Schellberg Dieter, Katus Hugo A, Grundtvig Morten, Hole Torstein, Atar Dan, Agewall Stefan, Frankenstein Lutz
机构信息
From the Department of Cardiology, University of Heidelberg, Heidelberg, Germany (H.F., J.Z., T.T., R.C., D.S., L.F.); Medical Department, Innlandet Hospital Trust Division Lillehammer, Lillehammer, Norway (M.G.); Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway (T.H.); Medical Clinic, Helse Møre and Romsdal HF, Ålesund, Norway (T.H.); and Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Oslo, Norway (D.A., S.A.).
出版信息
Circ Heart Fail. 2015 Sep;8(5):887-96. doi: 10.1161/CIRCHEARTFAILURE.114.001701. Epub 2015 Jul 14.
BACKGROUND
β-Blockers exert a prognostic benefit in the treatment of chronic heart failure. Their pharmacological properties vary. The only substantial comparative trial to date-the Carvedilol or Metoprolol European Trial-has compared carvedilol with short-acting metoprolol tartrate at different dose equivalents. We therefore addressed the relative efficacy of equal doses of carvedilol and metoprolol succinate on survival in multicenter hospital outpatients with chronic heart failure.
METHODS AND RESULTS
Four thousand sixteen patients with stable systolic chronic heart failure who were using either carvedilol or metoprolol succinate were identified in the Norwegian Heart Failure Registry and The Heart Failure Registry of the University of Heidelberg, Germany. Patients were individually matched on both the dose equivalents and the respective propensity scores for β-blocker treatment. During a follow-up for 17 672 patient-years, it was found that 304 (27.2%) patients died in the carvedilol group and 1066 (36.8%) in the metoprolol group. In a univariable analysis of the general sample, metoprolol therapy was associated with higher mortality compared with carvedilol therapy (hazard ratio, 1.49; 95% confidence interval, 1.31-1.69; P<0.001). This difference was not seen after multivariable adjustment (hazard ratio, 0.93; 95% confidence interval, 0.57-1.50; P=0.75) and adjustment for propensity score and dose equivalents (hazard ratio, 1.06; 95% confidence interval, 0.94-1.20; P=0.36) or in the propensity and dose equivalent-matched sample (hazard ratio, 1.00; 95% confidence interval, 0.82-1.23; P=0.99). These results were essentially unchanged for all prespecified subgroups.
CONCLUSIONS
In outpatients with chronic heart failure, no conclusive association between all-cause mortality and treatment with carvedilol or metoprolol succinate was observed after either multivariable adjustment or multilevel propensity score matching.
背景
β受体阻滞剂在慢性心力衰竭治疗中具有预后益处。它们的药理特性各不相同。迄今为止唯一一项实质性的比较试验——卡维地洛或美托洛尔欧洲试验——比较了不同剂量等效物的卡维地洛与短效酒石酸美托洛尔。因此，我们探讨了等量的卡维地洛和琥珀酸美托洛尔对多中心慢性心力衰竭门诊患者生存的相对疗效。
方法与结果
在挪威心力衰竭登记处和德国海德堡大学心力衰竭登记处中，识别出4016例正在使用卡维地洛或琥珀酸美托洛尔的稳定收缩期慢性心力衰竭患者。患者在剂量等效物以及β受体阻滞剂治疗的各自倾向评分方面进行个体匹配。在17672患者年的随访期间，发现卡维地洛组有304例（27.2%）患者死亡，美托洛尔组有1066例（36.8%）患者死亡。在对总体样本的单变量分析中，与卡维地洛治疗相比，美托洛尔治疗与更高的死亡率相关（风险比，1.49；95%置信区间，1.31 - 1.69；P<0.001）。多变量调整后（风险比，0.93；95%置信区间，0.57 - 1.50；P = 0.75）以及倾向评分和剂量等效物调整后（风险比，1.06；95%置信区间，0.94 - 1.20；P = 0.36）或在倾向和剂量等效物匹配样本中（风险比，1.00；95%置信区间，0.82 - 1.23；P = 0.99）未观察到这种差异。所有预先设定的亚组的这些结果基本未变。
结论
在慢性心力衰竭门诊患者中，多变量调整或多水平倾向评分匹配后，未观察到全因死亡率与卡维地洛或琥珀酸美托洛尔治疗之间有确凿关联。
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