A comparative analysis of the results from 4 trials of β-blocker therapy for heart failure:: BEST, CIBIS-II, MERIT-HF, and COPERNICUS
A comparative analysis of the results from 4 trials of β-blocker therapy for heart failure:: BEST, CIBIS-II, MERIT-HF, and COPERNICUS
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DOI：
10.1054/s1071-9164(03)00133-7
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发表时间：
2003-10-01
影响因子：
6
通讯作者：
Eichhorn, E
中科院分区：
文献类型：
--
作者：
Domanski, MJ;Krause-Steinrauf, H;Eichhorn, E
背景：最近的大型随机对照试验（BEST [β受体阻滞剂生存评估试验]，CIBIS-II[心功能不全比索洛尔试验II]， COPERNICUS[卡维地洛前瞻性随机累积生存研究]和mert - hf[美托洛尔随机干预充血性心力衰竭试验]）已经解决了β受体阻滞剂治疗晚期心力衰竭的有效性。CIBIS-II、COPERNICUS和MERIT-HF研究表明，β受体阻滞剂分别应用比索洛尔、卡维地洛和美托洛尔XL可降低晚期心力衰竭患者的死亡率，而BEST研究发现布辛多洛降低死亡率的趋势在统计学上不显著。我们进行了一项事后分析，以确定BEST对β -阻断剂的反应是否与研究人群的临床和人口统计学特征的差异有关。我们从BEST中提取了一个样本，与CIBIS-II和MERIT-HF研究的患者队列相似，以确定对β受体阻滞剂治疗的反应是否与其他试验中报道的相似。这些结果进一步与COPERNICUS进行了比较，COPERNICUS进入了更严重的心力衰竭患者。方法：为了符合CIBIS-II和MERIT-HF的入组标准，对BEST研究人群进行了调整，排除了有收缩压的患者
Background: Recent large randomized, controlled trials (BEST [beta-blocker Evaluation of Survival Trial], CIBIS-II [Cardiac Insufficiency Bisoprolol Trial II], COPERNICUS [Carvedilol Prospective Randomized Cumulative Survival Study], and MERIT-HF [Metoprolol Randomized Intervention Trial in Congestive Heart Failure]) have addressed the usefulness of beta-blockade in the treatment of advanced heart failure. CIBIS-II, COPERNICUS, and MERIT-HF have shown that beta-blocker treatment with bisoprolol, carvedilol, and metoprolol XL, respectively, reduce mortality in advanced heart failure patients, whereas BEST found a statistically nonsignificant trend toward reduced mortality with bucindolol. We conducted a post hoc analysis to determine whether the response to beta-blockade in BEST could be related to differences in the clinical and demographic characteristics of the study populations. We generated a sample from BEST to resemble the patient cohorts studied in CIBIS-II and MERIT-HF to find out whether the response to beta-blocker therapy was similar to that reported in the other trials. These findings are further compared with COPERNICUS, which entered patients with more severe heart failure.Methods: To achieve conformity with the entry criteria for CIBIS-II and MERIT-HF, the BEST study population was adjusted to exclude patients with systolic blood pressure