Randomized active-controlled study comparing effects of treatment with carvedilol versus metoprolol in patients with left ventricular dysfunction after acute myocardial infarction.
BACKGROUND
Carvedilol has previously been demonstrated to be beneficial in patients with acute myocardial infarction (AMI) and left ventricular (LV) dysfunction. However, metoprolol has not to date been randomly evaluated in the same patient population. The objective of this study was to compare the effects of treatment with carvedilol versus metoprolol in patients with LV dysfunction after AMI.


METHODS
The study enrolled 313 high-risk patients with anterior AMI and LV ejection fraction of <45%, randomly assigned to treatment with carvedilol or metoprolol. Patients were followed-up for a mean period of 13.4 months. The primary end point was time to composite adverse events (t-CAE). The secondary end points were time to composite hard events (t-CHE) and health-related quality of life.


RESULTS
No differences were found either in the primary end point of t-CAE or in the secondary end point of t-CHE. A significant benefit was observed in 4 of 8 health-related quality of life domains in the carvedilol group, with fewer carvedilol group patients being withdrawn from therapy in the hospital.


CONCLUSIONS
Treatment with carvedilol, in comparison to that with metoprolol in patients with AMI and LV dysfunction, did not differ significantly in regard to the primary end point of t-CAE or to the secondary end point of t-CHE but resulted in better long-term quality of life and favorable early safety profile.
Mrdovic
Igor Bogdan
IB
Institute for Cardiovascular Diseases, Emergency Hospital, Clinical Centre of Serbia, Belgrade, Serbia. igormr@beocity.net
Savic
Lidija Zlatimir
LZ
Perunicic
Jovan Petar
JP
Asanin
Milika Risto
MR
Lasica
Ratko Milorad
RM
Jelena
Marinkovic Milutin
MM
Matic
Mihailo Dragomir
MD
Vasiljevic
Zorana Mihailo
ZM
Ostojic
Miodrag Caslav
MC
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011412:Propanolamines / Q000627:therapeutic use*; D011788:Quality of Life; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol