BEST研究课件（PPT 7页）.ppt

BEST: Beta-blocker Evaluation Survival Trial Purpose To determine whether the β-blocker bucindolol reduces morbidity and mortality in patients with advanced heart failure Reference The BEST Investigators. A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med 2001;344:1659–67. BEST: Beta-blocker Evaluation Survival Trial- TRIAL DESIGN - Design Multicenter, randomized, double-blind, placebo-controlled Patients 2708 patients with NYHA class III/IV heart failure due to primary or secondary dilated cardiomyopathy, of which 59% were due to ischemic heart disease, with left ventricular ejection fraction 35%; patients with MI in previous 6 months excluded Follow up and primary endpoint Primary endpoint: all-cause mortality. Mean 24 months follow up Treatment Placebo or bucindolol 3 mg twice daily, increased as tolerated over several weeks to 50 mg twice daily (100 mg twice daily for patients 75 kg) BEST: Beta-blocker Evaluation Survival Trial- RESULTS - Trial halted early because mortality not significantly different in bucindolol and placebo groups (30 vs. 33%, P=0.10) Bucindolol group had significantly lower: death from cardiovascular causes (25 vs. 29%, P=0.04) hospitalization due to heart failure (35 vs. 42%, P0.001) In pre-specified subgroups: significant interaction effect between treatment and race (c2=5.06, P=0.02), reflecting benefit in non-Black and lack of benefit in Black patients non-significant trend towards improved survival in less advanced heart failure (LV ejection fraction 20%, NYHA class III); no survival benefit in more advanced heart failure Bucindolol well tolerated as defined by withdrawal rate from trial: marginally higher with placebo BEST: Beta-blocker Evaluation Survival Trial- RESULTS continued- BEST: Beta-blocker Evaluation Survival Trial- RESULTS continued- BEST: Beta-blocker Evaluation Survival Trial- RESULTS continued- BEST: Beta-blocker Evaluation Survival Tri