BEST研究PPT课件.ppt

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1、BEST:Beta-blockerEvaluationSurvivalTrialPurposeTodeterminewhethertheβ-blockerbucindololreducesmorbidityandmortalityinpatientswithadvancedheartfailureReferenceTheBESTInvestigators.Atrialofthebeta-blockerbucindololinpatientswithadvancedchronicheartfailure.NEnglJMed2001;344:1659–67.BES

2、T:Beta-blockerEvaluationSurvivalTrial-TRIALDESIGN-DesignMulticenter,randomized,double-blind,placebo-controlledPatients2708patientswithNYHAclassIII/IVheartfailureduetoprimaryorsecondarydilatedcardiomyopathy,ofwhich59%wereduetoischemicheartdisease,withleftventricularejectionfraction<3

3、5%;patientswithMIinprevious6monthsexcludedFollowupandprimaryendpointPrimaryendpoint:all-causemortality.Mean24monthsfollowupTreatmentPlaceboorbucindolol3mgtwicedaily,increasedastoleratedoverseveralweeksto50mgtwicedaily(100mgtwicedailyforpatients>75kg)BEST:Beta-blockerEvaluationSurviv

4、alTrial-RESULTS-Trialhaltedearlybecausemortalitynotsignificantlydifferentinbucindololandplacebogroups(30vs.33%,P=0.10)Bucindololgrouphadsignificantlylower:deathfromcardiovascularcauses(25vs.29%,P=0.04)hospitalizationduetoheartfailure(35vs.42%,P<0.001)Inpre-specifiedsubgroups:signifi

5、cantinteractioneffectbetweentreatmentandrace(c2=5.06,P=0.02),reflectingbenefitinnon-BlackandlackofbenefitinBlackpatientsnon-significanttrendtowardsimprovedsurvivalinlessadvancedheartfailure(LVejectionfraction<20%,NYHAclassIII);nosurvivalbenefitinmoreadvancedheartfailureBucindololwel

6、ltoleratedasdefinedbywithdrawalratefromtrial:marginallyhigherwithplaceboBEST:Beta-blockerEvaluationSurvivalTrial-RESULTScontinued-MonthsafterrandomizationProbabilityofsurvival00.061218243630421.00.80.60.4SurvivalaccordingtotreatmentgroupP=0.01PlaceboBucindololTheBESTInvestigators.NE

7、nglJMed2001;344:1659–67.BEST:Beta-blockerEvaluationSurvivalTrial-RESULTScontinued-P*PrimaryendpointDeathfromanycauseSecondaryendpointsDeathCardiovascularcausesNoncardiovascularcausesUnknowncausesHospitalizationAnyadmissionAdmissionduetochronicheartfailure0.90(0.78–1.02)0.86(0.74–0.9

8、9)1.19(0.79–1.78)0.