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- 发布时间：2017/6/9 14:45:13
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- 幻灯介绍：
Carvedilol Or Metoprolol European Trial
Presented at
European Heart Failure Meeting 2003
COMET Trial
Carvedilol
(target dose 25 mg twice daily)
A multiple adrenergic inhibitor
(n = 1,511)
Metoprolol tartrate
(target dose 50 mg twice daily)
A beta-1 blockade agent
(n = 1,518)
Endpoints (mean follow-up 58 months):
Primary – 1) All-cause mortality and 2) All-cause mortality or all-cause hospitalization
Secondary – Composite of all cause mortality or cardiovascular hospitalization; Composite of cardiovascular death, non-fatal acute MI, or heart transplantation; Worsening of heart failure; Cardiovascular death; NYHA class
COMET Trial
European Heart Failure Meeting 2003
3,029 patients with Class III-IV heart failure
Enrolled at 317 centers in 15 European countries
COMET Trial: Primary Endpoint Analysis
All-cause mortality
European Heart Failure Meeting 2003
HR 0.83
95% CI 0.74-0.93
p=0.0017
COMET Trial: Primary Endpoint Analysis
All-cause mortality or all-cause hospitalization
European Heart Failure Meeting 2003
HR 0.93
95% CI 0.86-1.10
p=0.1222
COMET: Dosing Issues
Metoprolol-Tartrate (immediate release)
Target dose: 2 x 50 mg tartrate ~78 mg Metoprolol
Metoprolol-Succinate (CR/XR)
Target dose: 1 x 190 mg succinate ~155 mg Metoprolol
(achieved mean dose in MERIT-HF ~130 mg)
COMET
MERIT-HF
Metoprolol Tartrate
Metoprolol Succinate
Slide Provided by: Dr. med. M. Elsner, Medizinische Klinik I, St. Josefs Hospital, Solmsstr. 15, 65189, Wiesbaden, Germany, Tel./Fax: +49-611-177-1205. Dr. Elsner has no conflict of interest to declare.
COMET Trial: Summary
First randomized morality trial to compare 2 beta-blockers in patients with CHF
Treatment with carvedilol was associated with ? rate of all-cause mortality (primary endpoint) but was not associated with difference in co-primary endpoint of all-cause mortality or all-cause hospitalization in patients with CHF
Trial used immediate-release formulation of metoprolol tartrate not controlled-release formulation of metoprolol succinate used in MERIT HF trial, the main trial showing a benefit of metoprolol compared with placebo in heart failure patients