MDC (Waagstein), 1993 metoprolol versus placebo

Lancet 1993;342:1441-6  

metoprolol versus placebo in patient with heart failure due to idiopathic dilated cardiomyopathy (NYHA 1-3) and EF<40%




Studied treatment metoprolol target dose 100-150 mg daily (dose divided into two or three per day)
the daily dose increased over 6 weeks from week 1 10mg, week 2 15mg, week 3 30 mg, week 4 50mg, week 5 75mg, week 6 100mg, week 7 and onwards 150mg
Control treatment placebo
Concomittant treatmentdigitalis, diuretics, ACE inhibitors, nitrates for a state of compensated heart failure



Patients patient with heart failure due to idiopathic dilated cardiomyopathy (NYHA 1-3) and EF<40%
Group sizes 194 / 189
Inclusion criteriaage 1--75 years; synptomatic dilated cardiomyopathy and ejection fraction below à.40;
Exclusion criteriatreatment with beta-blockers, calcium antagonists, inotropic agent (except digitalis); significant coronary artery disease; myocarditis; other life threatening disease; obstructive lung disease; insulin dependant diabetes; heart rate<45/min; SBP<90mmHg
run-in phase No



Blindness Double blind Inclusion period Sept 1986 - Jul 1991
Follow-up duration 18 months Centers 33
Lost to FU NA geographical localisation Europe, North America
Primary endpoint death or transplantation waiting list Design Parallel groups



EndpointX1N1X0N0TE95% CI all cause death 23 194 21 189 1,07[0,57; 2,00] death or HF hospitalisation 48 194 61 189 0,77[0,49; 1,20] hospitalisation for heart failure 37 194 49 189 0,74[0,45; 1,19] NYHA improvement 67 194 52 189 1,26[0,81; 1,94] LV ejection fraction - -9 - -9 no data fatal and non fatal cardiovascular event - 194 - 189 no data Sudden death - 194 - 189 no data fatal and non fatal coronary event - 194 - 189 no data coronary death - 194 - 189 no data cardiovascular death - 194 - 189 no data NYHA deterioration 8 194 9 189 0,87[0,33; 2,29]0,22,01,0


Waagstein F, Bristow MR, Swedberg K, Camerini F, Fowler MB, Silver MA, Gilbert EM, Johnson MR, Goss FG, Hjalmarson A Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Lancet 1993;342:1441-6     [PMID: 7902479]   link to pdf  

 




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