Carvedilol Protects Better Against Vascular Events Than Metoprolol in Heart FailureResults From COMET
Willem J. Remme, MD, PhD, FACC, FAHA, FESC*,*,
Christian Torp-Pedersen, MD, FESC, FACC ,
John G.F. Cleland, MD, FRCP, FESC, FACC ,
Philip A. Poole-Wilson, MD, FRCP, FESC, FACC ,
Marco Metra, MD||,
Michel Komajda, MD, PhD, FESC¶,
Karl Swedberg, MD, PhD, FESC, FACC#,
Andrea Di Lenarda, MD, FESC**,
Phillip Spark, BSc (Hons),
Armin Scherhag, MD,1,
Christine Moullet, MD,1 and
Mary Ann Lukas, MD,1
* Sticares Cardiovascular Research Institute, Rhoon, the Netherlands
Bispebjerg University Hospital, Copenhagen, Denmark
University of Hull, Kingston-upon-Hull, United Kingdom
National Heart and Lung Institute, Imperial College, London, United Kingdom
|| Department of Cardiology, University of Brescia, Brescia, Italy
¶ Pitié Salpetrière Hospital, Paris, France
# Sahlgrenska University Hospital, Gothenburg, Sweden
** Ospedale di Cattinara, University of Trieste, Trieste, Italy
Nottingham Clinical Research Group, Nottingham, United Kingdom
F. Hoffmann-La Roche, Basel, Switzerland
GlaxoSmithKline, Philadelphia, Pennsylvania.
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Figure 1 Risk of Cardiovascular Death by Subgroups With Predefined Baseline Variables
Carvedilol consistently improves cardiovascular death compared with metoprolol. af = atrial fibrillation; Asp/anticoag = aspirin/anticoagulant; CI = confidence interval; ECG = electrocardiogram; HR = hazard ratio; IHD = ischemic heart disease; LVEF = left ventricular ejection fraction; MI = myocardial infarction; NYHA = New York Heart Association functional classification.
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Figure 2 Effect of Carvedilol Compared With Metoprolol on Single and Combined Vascular Events
With few exceptions, carvedilol (Carv) consistently reduces vascular event risk. AE = adverse event; CV = cardiovascular; hosp = hospitalization; Meto = metoprolol; other abbreviations as in Figure 1.
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Figure 3 Kaplan-Meier Plots of Time to Fatal MI, Any Stroke, Fatal MI or Stroke, and Any MI or Stroke in the 2 Treatment Groups
There were significantly fewer events in the carvedilol group than in the metoprolol group for all these end points barring any stroke. The effect of carvedilol started early and was constant over time. MI = myocardial infarction.
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Figure 4 Kaplan-Meier Curves of the Combined End Point of any MI, Unstable Angina, and Stroke
Significant greater reduction of the combined end point of any myocardial infarction (MI), unstable angina, and stroke with carvedilol than with metoprolol.
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Figure 5 Time to CV Death or Nonfatal MI, Death or Nonfatal MI, CV Death, Nonfatal MI, or Any Stroke
Kaplan-Meier curves for the combined end point of cardiovascular (CV) death or nonfatal myocardial infarction (MI) (A), all-cause death or nonfatal MI (B), and CV death, nonfatal MI, or any stroke (C).
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Figure 6 Kaplan-Meier Curves for Death After a Nonfatal Myocardial Infarction or Nonfatal Stroke
Carvedilol significantly reduces death after a nonfatal myocardial infarction or stroke compared with metoprolol.
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