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

Am J Ther. May-Jun 2013;20(3):247-53. doi: 10.1097/MJT.0b013e3181f2abb3.

Abstract

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.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Aged, 80 and over
  • Carbazoles / therapeutic use*
  • Cardiac Resynchronization Therapy*
  • Carvedilol
  • 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

Substances

  • Adrenergic beta-Antagonists
  • Carbazoles
  • Propanolamines
  • Carvedilol
  • Metoprolol