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Effect of Metoprolol Versus Carvedilol on Outcomes in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy)
- Source :
- Journal of the American College of Cardiology. 61(14):1518-1526
- Publication Year :
- 2013
- Publisher :
- Elsevier BV, 2013.
-
Abstract
- ObjectivesThis study sought to compare the effects of metoprolol and carvedilol in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study.BackgroundThe impact of beta-blockers in heart failure (HF) patients with devices is uninvestigated.MethodsAll patients receiving either metoprolol or carvedilol in the MADIT-CRT study were identified and compared. Time-dependent Cox proportional hazard regression analyses were performed to assess differences in hospitalization for HF or death and ventricular arrhythmias.ResultsHospitalization for HF or death occurred in 30% of the patients on metoprolol and in 23% on carvedilol. Treatment with carvedilol was associated with a significantly decreased risk of hospitalization for HF or death when compared with metoprolol (hazard ratio [HR]: 0.70, [95% confidence interval (CI): 0.57 to 0.87], p = 0.001). This reduction in risk was further attenuated in the subgroup of cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) patients (HR: 0.61 [95% CI: 0.46 to 0.82], p = 0.001) and CRT-D patients with left bundle branch block (LBBB) (HR: 0.51 [95% CI: 0.35 to 0.76], p < 0.001). Ventricular arrhythmias occurred in 26% and in 22%, respectively, of the patients receiving metoprolol or carvedilol (HR: 0.80 [95% CI: 0.63 to 1.00], p = 0.050). General use of beta-blockers and adherence in this study was high, and a clear dose-dependent relationship was found in carvedilol, but not in metoprolol.ConclusionsIn HF patients in New York Heart Association functional class I and II and with wide QRS complexes, carvedilol was associated with a 30% reduction in hospitalizations for HF or death when compared with metoprolol. A novel beneficial and synergistic effect of carvedilol was seen in patients with CRT-D and LBBB. Furthermore, we found a pronounced dose-dependent relationship in carvedilol, but not in metoprolol. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy; NCT00180271)
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Cardiac resynchronization therapy
heart failure
beta-blockers
Internal medicine
medicine
left bundle branch block
cardiovascular diseases
Carvedilol
resynchronization
Metoprolol
Ejection fraction
Left bundle branch block
business.industry
Hazard ratio
medicine.disease
Heart failure
Anesthesia
Cardiology
prognosis
business
Cardiology and Cardiovascular Medicine
Multicenter Automatic Defibrillator Implantation Trial
circulatory and respiratory physiology
medicine.drug
Subjects
Details
- ISSN :
- 07351097
- Volume :
- 61
- Issue :
- 14
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology
- Accession number :
- edsair.doi.dedup.....da2dc40f978522492c804236563ea60b
- Full Text :
- https://doi.org/10.1016/j.jacc.2013.01.020