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1、COMET:CarvedilolOrMetoprololEuropeanTrialPurposeTocomparetheeffectsofcarvedilol(aβ1-,β2-andα1-receptorblocker)andshort-actingmetoprololtartrate(aβ1-receptorblocker)onclinicaloutcomeinpatientswithchronicheartfailureReferencePoole-WilsonPA,SwedbergK,ClelandJGFetal.fortheCOM
2、ETInvestigators.ComparisonofcarvedilolandmetoprololonclinicaloutcomesinpatientswithchronicheartfailureintheCarvedilolOrMetoprololEuropeanTrial(COMET):randomisedcontrolledtrial.Lancet2003;362:7–13.COMET:CarvedilolOrMetoprololEuropeanTrial-TRIALDESIGN-DesignMulticenter,mult
3、inational,randomized,double-blind,parallelgroupPatients3029patientsinNYHAclassII–IV,previouslyhospitalizedforacardiovascularreason,whohadleftventricularejectionfraction<0.35andwerereceivingoptimaltreatmentwithdiureticsandACEinhibitorsunlessnottoleratedFollowupandprimaryen
4、dpointPrimaryendpoint:all-causemortality.Mean4.8yearsfollowup.TreatmentShort-actingmetoprololtartratetitratedtotargetdose50mgtwicedailyorcarvediloltitratedtotargetdose25mgtwicedailyCOMET:CarvedilolOrMetoprololEuropeanTrial-TRIALDESIGNcontinued-Age(years)aMaleNYHAclassIIII
5、IIVHeartfailurecauseIschemicheartdiseaseHypertensionDilatedcardiomyopathyPreviousvalvesurgeryLeftventricularejectionfractionaNT-proBNP(mg/L)bMedicationsDiureticsACEinhibitorsAngiotensinreceptorantagonistsAldosteroneantagonistsBaselinecharacteristics(%)62.380494745418442Me
6、toprololtartrate(n=1518)61.679484835118443Carvedilol(n=1511)aMeanbMedian0.2611859991711Metoprololtartrate(n=1518)0.2612989992611Carvedilol(n=1511)Poole-Wilsonetal.Lancet2003;362:7–13.COMET:CarvedilolOrMetoprololEuropeanTrial-RESULTS-All-causemortalitysignificantlyreducedi
7、ncarvedilolgroupcomparedwithshort-actingmetoprololtartrate(34vs.40%,P=0.0017)Cardiovascularmortalitysignificantlyreduced(29vs.35%,P=0.0004)Nosignificantdifferenceincompositesecondaryendpointofall-causemortalityoradmission(74vs.76%,hazardratio0.94, 95%CI0.86–1.02,P=0.122):
8、Withdrawalrateidentical(32%)andincidenceofadverseeventssimilar(94vs.96%)inbothtreatmentgroupsCOM
