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Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias

The study investigates the prognostic role of treatment with carvedilol as compared to metoprolol in patients with ventricular tachyarrhythmias. A large retrospective registry was used including consecutive patients on beta-blocker (BB) treatment with episodes of ventricular tachycardia (VT) or fibr...

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Autores principales: Schupp, Tobias, Behnes, Michael, Abumayyaleh, Mohammad, Weidner, Kathrin, Rusnak, Jonas, Mashayekhi, Kambis, Bertsch, Thomas, Akin, Ibrahim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410246/
https://www.ncbi.nlm.nih.gov/pubmed/36005438
http://dx.doi.org/10.3390/jcdd9080274
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author Schupp, Tobias
Behnes, Michael
Abumayyaleh, Mohammad
Weidner, Kathrin
Rusnak, Jonas
Mashayekhi, Kambis
Bertsch, Thomas
Akin, Ibrahim
author_facet Schupp, Tobias
Behnes, Michael
Abumayyaleh, Mohammad
Weidner, Kathrin
Rusnak, Jonas
Mashayekhi, Kambis
Bertsch, Thomas
Akin, Ibrahim
author_sort Schupp, Tobias
collection PubMed
description The study investigates the prognostic role of treatment with carvedilol as compared to metoprolol in patients with ventricular tachyarrhythmias. A large retrospective registry was used including consecutive patients on beta-blocker (BB) treatment with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with carvedilol were compared to patients with metoprolol. The primary prognostic outcome was all-cause mortality at three years. Secondary endpoints comprised a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias, appropriate implantable cardioverter defibrillator (ICD) therapies) and cardiac rehospitalization. Kaplan–Meier survival curves, multivariable Cox regression analyses, and propensity score matching were applied for statistics. There were 1098 patients included, 80% treated with metoprolol and 20% with carvedilol. Patients with carvedilol were older, more often presenting with VT (78% vs. 62%; p = 0.001) and with more advanced stages of heart failure. Treatment with carvedilol was associated with comparable all-cause mortality compared to metoprolol (20% vs. 16%, log rank p = 0.234; HR = 1.229; 95% CI 0.874–1.728; p = 0.235). However, secondary endpoints (i.e., composite arrhythmic endpoint: 32% vs. 17%; p = 0.001 and cardiac rehospitalization: 25% vs. 14%; p = 0.001) were more frequently observed in patients with carvedilol, which was still evident after multivariable adjustment. After propensity score matching (n = 194 patients with carvedilol and metoprolol), no further differences regarding the distribution of baseline characteristics were observed. Within the propensity-score-matched cohort, higher rates of the composite arrhythmic endpoint were still observed in patients treated with carvedilol, whereas the risk of cardiac rehospitalization was not affected by the type of beta-blocker treatment. In conclusion, carvedilol and metoprolol are associated with comparable all-cause mortality in patients with ventricular tachyarrhythmias, whereas the risk of the composite arrhythmic endpoint was increased in patients with carvedilol therapy.
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spelling pubmed-94102462022-08-26 Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias Schupp, Tobias Behnes, Michael Abumayyaleh, Mohammad Weidner, Kathrin Rusnak, Jonas Mashayekhi, Kambis Bertsch, Thomas Akin, Ibrahim J Cardiovasc Dev Dis Article The study investigates the prognostic role of treatment with carvedilol as compared to metoprolol in patients with ventricular tachyarrhythmias. A large retrospective registry was used including consecutive patients on beta-blocker (BB) treatment with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with carvedilol were compared to patients with metoprolol. The primary prognostic outcome was all-cause mortality at three years. Secondary endpoints comprised a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias, appropriate implantable cardioverter defibrillator (ICD) therapies) and cardiac rehospitalization. Kaplan–Meier survival curves, multivariable Cox regression analyses, and propensity score matching were applied for statistics. There were 1098 patients included, 80% treated with metoprolol and 20% with carvedilol. Patients with carvedilol were older, more often presenting with VT (78% vs. 62%; p = 0.001) and with more advanced stages of heart failure. Treatment with carvedilol was associated with comparable all-cause mortality compared to metoprolol (20% vs. 16%, log rank p = 0.234; HR = 1.229; 95% CI 0.874–1.728; p = 0.235). However, secondary endpoints (i.e., composite arrhythmic endpoint: 32% vs. 17%; p = 0.001 and cardiac rehospitalization: 25% vs. 14%; p = 0.001) were more frequently observed in patients with carvedilol, which was still evident after multivariable adjustment. After propensity score matching (n = 194 patients with carvedilol and metoprolol), no further differences regarding the distribution of baseline characteristics were observed. Within the propensity-score-matched cohort, higher rates of the composite arrhythmic endpoint were still observed in patients treated with carvedilol, whereas the risk of cardiac rehospitalization was not affected by the type of beta-blocker treatment. In conclusion, carvedilol and metoprolol are associated with comparable all-cause mortality in patients with ventricular tachyarrhythmias, whereas the risk of the composite arrhythmic endpoint was increased in patients with carvedilol therapy. MDPI 2022-08-16 /pmc/articles/PMC9410246/ /pubmed/36005438 http://dx.doi.org/10.3390/jcdd9080274 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schupp, Tobias
Behnes, Michael
Abumayyaleh, Mohammad
Weidner, Kathrin
Rusnak, Jonas
Mashayekhi, Kambis
Bertsch, Thomas
Akin, Ibrahim
Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias
title Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias
title_full Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias
title_fullStr Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias
title_full_unstemmed Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias
title_short Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias
title_sort carvedilol versus metoprolol in patients with ventricular tachyarrhythmias
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410246/
https://www.ncbi.nlm.nih.gov/pubmed/36005438
http://dx.doi.org/10.3390/jcdd9080274
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