tailieunhanh - Evidence-based Cardiology – part 8

Có những trường hợp tử vong đột ngột metoprolol CR / XL nhóm ít hơn so với nhóm dùng giả dược (79 v 132; RR 0,59, P 0,0002) và tử vong ít hơn từ xấu đi suy tim (30 v 58, RR 0,51, P 0,0023) 0,197 trong thử nghiệm TỐT NHẤT tác động của các bucindolol chặn không chọn lọc | Evidence-based Cardiology 11-0 RR 0-ỐỐ 95 CI 0-53-0-81 P 0-0009 . There were fewer sudden deaths in the metoprolol CR XL group than in the placebo group 79 v 132 RR 0-59 P 0-0002 and fewer deaths from worsening heart failure 30 v 58 RR 0-51 P 0-0023 .197 In the BEST trial the effects of the non-selective p blocker bucindolol was compared with placebo in 2708 patients with CHF in NYHA class Bucindolol was initiated with 3 mg 2x day and titrated up over Ố-8 weeks to 50-100 mg 2x day. The study was prematurely terminated by the safety committee. Mortality was reduced from 447 deaths to 409 deaths RR 0-91 95 CI 0-88-1-02 P 0-12 . In a subgroup analysis there was a heterogeneous response among groups analyzed. Patients with NYHA class IV or ejection fraction below 20 did not appear to benefit. Furthermore in a subgroup of African-Americans there was a 17 excess mortality suggesting a lack of benefit among these patients. However these were post hoc analyses and not prespecified end points. The recently reported COPERNICUS trial was performed in 2289 patients with symptomatic chronic heart failure with symptoms at rest or at minimal Carvedilol was initiated with 3-125 mg x2 day and titrated to 25 mg x2 day. There was a significant reduction in all-cause mortality from 190 18-5 per patient-year to 130 11-4 with a hazard ratio of 0-Ố5 95 CI 0-52-0-81 P 0-0001. The effect was consistent among a number of prespecified subgroups. In a post hoc subgroup analysis of patients in the MERIT-HF study with similar characteristics as the patients in the COPERNICUS trial with an EF of 0-25 and NYHA class III-IV there was a comparable reduction in all-cause mortality 45 11 v 72 18 deaths hazard ratio 0-Ố1 95 CI 0-11-0-58 P 0-008Ố .208 All three large p blocker studies CIBIS-II MERIT-HF COPERNICUS had been stopped early because of clear evidence of benefit and therefore resulted in limited long-term experience with this treatment. Nevertheless these trials have .