COMET
Trial question
Is carvedilol superior to metoprolol on clinical outcomes in patients with chronic HF?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
20.0% female
80.0% male
N = 3029
3029 patients (612 female, 2417 male).
Inclusion criteria: patients chronic HF (NYHA II-IV), previous cardiovascular admission, and LVEF < 35% on optimal medical treatment.
Key exclusion criteria: contraindication to use of β-blockers, history of asthma or COPD, PAD with symptoms at rest, or unstable insulin-dependent diabetes mellitus.
Interventions
N=1511 carvedilol (target dose 25 mg BID).
N=1518 metoprolol (target dose 50 mg BID).
Primary outcome
All-cause death
34%
40%
40.0 %
30.0 %
20.0 %
10.0 %
0.0 %
Carvedilol
Metoprolol
Significant
decrease ▼
NNT = 16
Significant decrease in all-cause death (34% vs. 40%; HR 0.83, 95% CI 0.74 to 0.93).
Secondary outcomes
No significant difference in death or hospital admission (74% vs. 76%; HR 0.94, 95% CI 0.86 to 1.02).
Safety outcomes
No significant difference in incidence of side-effects and drug withdrawals.
Conclusion
In patients chronic HF (NYHA II-IV), previous cardiovascular admission, and LVEF < 35% on optimal medical treatment, carvedilol was superior to metoprolol with respect to a all-cause death.
Reference
Poole-Wilson PA, Swedberg K, Cleland JG et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet. 2003 Jul 5;362(9377):7-13.
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