发布日期：2003 年 10 月
英文标题：
Metoprolol CR/XL in postmyocardial infarction patients with chronic heart failure: experiences from MERIT-HF.
作者：
Jánosi A, Ghali JK, Herlitz J, Czuriga I, Klibaner M, Wikstrand J, Hjalmarson A; MERIT-HF Study Group.
出处：
Am Heart J. 2003 Oct;146(4):721-8.
内容介绍：美托洛尔随机化干预慢性心衰患者研究（MERIT-HF）的心梗后心衰亚组分析，将 1926 例心梗后发生有症状性心衰的患者 (心功能 II-IV 级)，随机分入美托洛尔治疗组 (n＝950) 或安慰剂对照组 (n＝976)。采用 MERIT-HF 试验的治疗方案，即美托洛尔从小剂量开始逐步上调，目标剂量 200 mg/d。结果显示，安慰剂组和美托洛尔组的 1 年总死亡率分别为 12.8% 和 7.6%，即美托洛尔治疗使死亡相对危险降低 40%。此外，美托洛尔治疗组猝死相对危险率降低 50%，心衰恶化致死相对危险率降低 49%，总住院率降低 8%(P = NS)，心血管病住院率降低 17%，心衰恶化住院相对危险率降低 32%(P＝0．006)，死亡或心血管病住院相对危险率降低 22%(P＝0．002)。即使在当代最佳综合治疗的基础上，对于心梗后发生有症状性心力衰竭的患者，美托洛尔治疗仍能显著降低死亡率和住院率。
摘要展示：
BACKGROUND:
The benefit of beta-blockers post-myocardial infarction (MI) was established in the late 1970s. Major advances in the treatment of MI have since occurred. However, patients with chronic heart failure (CHF) were excluded from those trials. The purpose of this study was to assess the effect of beta-blockers in post-MI patients with CHF receiving contemporary management.
METHODS:
This was a prespecified subgroup analysis of a double-blind, randomized trial: the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF). Patients with CHF in New York Heart Association class II to IV with an ejection fraction (EF) < or = 0.40 and a history of being hospitalized for an acute MI (n = 1926) were randomized to metoprolol succinate controlled release/extended release (CR/XL) versus placebo. Mean EF was 0.28, and the mean follow-up was 1 year.
RESULTS:
Metoprolol CR/XL reduced total mortality by 40% (95% CI 0.20-0.55, P =.0004), and sudden death by 50% (95% CI 0.26-0.66, P =.0004). The combined end point of all-cause mortality/hospitalization for worsening CHF was reduced by 31% (95% CI 0.16-0.44, P <.0001), and cardiac death/nonfatal acute MI by 45% (95% CI 0.26-0.58, P <.0001). A post-hoc analysis showed that the outcome in patients with earlier revascularization (44%) and outcome in those with more severe CHF (20%) was similar to the entire post-MI population.
CONCLUSIONS:
In post-MI patients with symptomatic CHF, beta-blockade continues to exert a profound reduction in mortality and morbidity in the presence of contemporary management that includes early and late revascularization, angiotensin-converting enzyme inhibitors, aspirin, and statins.
