Effect of carvedilol versus metoprolol CR/XL on mortality in patients with heart failure treated with cardiac resynchronization therapy: a COX multivariate regression analysis

• Published in: American journal of therapeutics Vol. 20; no. 3; p. 247
• Main Authors: Shen, Xuedong, Nair, Chandra K, Aronow, Wilbert S, Hee, Tom, Esterbrooks, Dennis J
• Format: Journal Article
• Language: English
• Published: United States 01.05.2013
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Aged, 80 and over; Carbazoles - therapeutic use; Cardiac Resynchronization Therapy; Combined Modality Therapy; Drug Administration Schedule; Female; Follow-Up Studies; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - therapy; Humans; Male; Maximum Tolerated Dose; Metoprolol - analogs & derivatives; Metoprolol - therapeutic use; Middle Aged; Multivariate Analysis; Propanolamines - therapeutic use; Proportional Hazards Models; Treatment Outcome; Ultrasonography
• ISSN: 1536-3686
• DOI: 10.1097/MJT.0b013e3181f2abb3

We investigated in 136 consecutive patients with heart failure receiving cardiac resynchronization therapy (CRT) the effect of carvedilol versus metoprolol CR/XL versus no beta blocker on mortality. Of the 136 patients, 42 (31%) were on carvedilol, 80 (59%) were on metoprolol CR/XL, and 14 (10%) were not on a beta blocker. A decrease of left ventricular end-systolic volume ≥15% after CRT was defined as a positive response to CRT. Of the 136 patients, 62 (46%) responded to CRT. It was found that both carvedilol and metoprolol CR/XL were not related to CRT response on using Cox univariate regression analysis. Twenty-two of the 136 patients (16%) died during follow-up of 17 ± 10 months after initiating CRT. Mortality occurred in 14 of 80 patients (18%) on metoprolol CR/XL, in 3 of 42 patients (7%) on carvedilol, and in 5 of 14 patients (36%) not on beta blockers (P = 0.04). After adjustment for age, gender, and the variables with significant differences by Cox univariate regression, both carvedilol (hazard ratio = 0.14; P = 0.03; 95% confidence interval = 0.02-0.86) and metoprolol CR/XL (hazard ratio = 0.19; P = 0.02; 95% confidence interval = 0.04-0.80) were found to be related to mortality by Cox multivariate regression.