Superiority of Long-Acting to Short-Acting Loop Diuretics in the Treatment of Congestive Heart Failure - The J-MELODIC Study -
Superiority of Long-Acting to Short-Acting Loop Diuretics in the Treatment of Congestive Heart Failure - The J-MELODIC Study -
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DOI：
10.1253/circj.cj-11-1500
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发表时间：
2012-04-01
影响因子：
3.3
通讯作者：
Ito, Hiroshi
中科院分区：
文献类型：
--
作者：
Masuyama, Tohru;Tsujino, Takeshi;Ito, Hiroshi
背景：利尿剂是心力衰竭（HF）患者最常用的处方药。然而，缺乏关于其长期疗效的临床证据。本研究的目的是比较短效袢利尿剂呋塞米和长效袢利尿剂阿佐塞米在慢性心力衰竭（CHF）患者中的治疗效果。
方法与结果：在这项多中心、前瞻性、随机、开放、盲法终点试验中，我们比较了阿佐塞米和呋塞米对纽约心脏协会（NYHA）心功能Ⅱ级或Ⅲ级的慢性心力衰竭患者的疗效。320例患者（每组160例，平均年龄71岁）接受了至少2年的随访。主要终点是心血管死亡或因充血性心力衰竭意外入院的复合终点。在中位随访35.2个月期间，阿佐塞米组23例患者出现主要终点，呋塞米组34例患者出现主要终点（风险比[HR]，0.55；95%置信区间[CI]，0.32 - 0.95；P = 0.03）。在次要终点中，与呋塞米组相比，阿佐塞米组因充血性心力衰竭意外入院或需要调整心力衰竭治疗的情况也有所减少（HR，0.60；95%CI，0.36 - 0.99；P = 0.048）。
结论：与呋塞米相比，阿佐塞米降低了心血管死亡或因充血性心力衰竭意外入院的风险。（《循环杂志》2012年；76卷：833 - 842页）
Background: Diuretics are the most prescribed drug in heart failure (HF) patients. However, clinical evidence about their long-term effects is lacking. The purpose of this study was to compare the therapeutic effects of furosemide and azosemide, a short- and long-acting loop diuretic, respectively, in patients with chronic heart failure (CHF).Methods and Results: In this multicenter, prospective, randomized, open, blinded endpoint trial, we compared the effects of azosemide and furosemide in patients with CHF and New York Heart Association class II or III symptoms. 320 patients (160 patients in each group, mean age 71 years) were followed up for a minimum of 2 years. The primary endpoint was a composite of cardiovascular death or unplanned admission to hospital for congestive HF. During a median follow-up of 35.2 months, the primary endpoint occurred in 23 patients in the azosemide group and in 34 patients in the furosemide group (hazard ratio [HA], 0.55, 95% confidence interval [CI] 0.32-0.95: P=0.03). Among the secondary endpoints, unplanned admission to hospital for congestive HF or a need for modification of the treatment for HF were also reduced in the azosemide group compared with the furosemide group (HR, 0.60, 95%CI 0.36-0.99: P=0.048).Conclusions: Azosemide, compared with furosemide, reduced the risk of cardiovascular death or unplanned admission to hospital for congestive HF. (Circ J 2012; 76: 833-842)