Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention

Roolvink, Vincent; Ibáñez, Borja; Ottervanger, Jan Paul; Pizarro, Gonzalo; Royen, Niels van; Mateos, Alonso; Dambrink, Jan‐Henk E.; Escalera, Noemí; Lipšic, Erik; Albarrán, Agustín; Fernández‐Ortíz, Antonio; Fernández-Avilés, Francisco; Goicolea, Javier; Botas, Javier; Remkes, Wouter; Hernandez-Jaras, Victoria; Kedhi, Elvin; Zamorano, José Luís; Navarro, Felipe; Alfonso, Fernándo; García‐Lledó, Alberto; Alonso, Joaquín; Leeuwen, Maarten van; Nijveldt, Robin; Postma, Sonja; Kolkman, Evelien; Gosselink, Marcel; Smet, Bart de; Rasoul, Saman; Piek, Jan J.; Fuster, Valentín; Hof, Arnoud W J van ‘t

doi:10.1016/j.jacc.2016.03.522

Cited by 152 publications

(93 citation statements)

References 23 publications

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“…Accordingly, in a large observational study (>44,000 patients), beta-blockers were not associated with mortality benefit in patients with prior MI or those without a history of AMI (23). Our observations support the argument that in the current clinical practice incremental survival benefits associated with use of beta-blockers may be smaller than benefits associated with use of the other 2 evidence-based preventive therapies (23–25). …”

Section: Discussionsupporting

confidence: 84%

Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

Korhonen

Robinson

Annis

et al. 2017

Journal of the American College of Cardiology

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BACKGROUND Angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB), beta-blockers and statins are recommended after acute myocardial infarction (AMI). Patients may adhere to some but not all therapies. OBJECTIVE We investigated the effect of trade-offs in adherence to ACEI/ARBs, beta-blockers, and statins on survival among older people after AMI. METHODS We identified 90,869 Medicare beneficiaries aged ≥65 who had prescription of ACEI/ARBs, beta-blockers and statins and survived ≥180 days after AMI hospitalization in 2008−2010. Adherence was measured by proportion of days covered (PDC) during 180 days following hospital discharge. Mortality follow-up extended up to 18 months after this period. We used Cox proportional hazards models to estimate hazard ratios of mortality for groups adherent to 2, 1 or none of the therapies versus group adherent to all 3 therapies. RESULTS Only 49% of the patients adhered (PDC ≥80%) to all 3 therapies. Compared to being adherent to all 3 therapies, multivariable-adjusted hazard ratios (95% confidence intervals [95%CI]) for mortality were 1.12 (1.04 to 1.21) for being adherent to ACEI/ARBs and beta-blockers only, 0.98 (0.91 to 1.07) for ACEI/ARBs and statins only, 1.17 (1.10 to 1.25) beta-blockers and statins only, 1.19 (1.07 to 1.32) for ACEI/ARBs only, 1.32 (1.21 to 1.44) for beta-blockers only, 1.26 (1.15 to 1.38) statins only, and 1.65 (1.54 to 1.76) for being nonadherent (PDC <80%) to all 3 therapies. CONCLUSIONS Patients adherent to ACEI/ARBs and statins only had similar mortality as those adherent to all 3 therapies, suggesting limited additional benefit for beta-blockers in patients who were adherent to statins and ACE/ARBs. Nonadherence to ACEI/ARBs and/or statins was associated with higher mortality.

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Section: Discussionsupporting

confidence: 84%

Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

Korhonen

Robinson

Annis

et al. 2017

Journal of the American College of Cardiology

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“…In the reperfusion era, the COMMIT trial indicated that there was more developing cardiogenic shock per 1000 persons (5·0% vs. 3·9%; p<0.00001) allocated to metoprolol group, especially on days 0 and 19. In a Swedish nationwide observational study, the use of intravenous beta-blockers in STEMI patients without cardiogenic shock and cardiac arrest at presentation treated with primary PCI was associated with higher short-term mortality, lower LVEF at discharge, as well as a higher risk of in-hospital cardiogenic shock [14,15]. While recent meta-analysis concluded that early use of intravenous beta-blockers in STEMI patients presenting in Killip Class 1 or 2 was not associated with increase in the risk of cardiogenic shock in the current reperfusion era [11,12].…”

Section: Cardiogenic Shockmentioning

confidence: 99%

“…Global [13]. This beneficial effect on infarct size and LVEF; however, was not demonstrated in another similar designed study [14]. A recent metaanalysis of four trails only enrolled patients with confirmed STEMI with symptoms lasting less than 6 or less than 12 h concluded that intravenous beta-blockers in conjunction with PCI are associated with improved LVEF at 24 weeks in STEMI patients presenting in Killip Class 1 or 212.…”

Section: Infarct Size and Left Ventricular Ejection Fraction (Lvef)mentioning

confidence: 99%

Early Intravenous Beta-blockers for Acute Myocardial Infarction

Guo¹,

He²,

Fu³

2017

J Clin Exp Cardiolog

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Early intravenous beta-blockers reduce the risk of recurrent ischaemia and ventricular arrhythmia in the treatment of acute myocardial infarction. These beneficial efficacy, however, are balanced by a high rate of cardiogenic shock. It has great significance for reliable identification of subgroups of patients among whom treatment is really advantageous. The present article is a review on the efficacy and safety of the early intravenous beta-blockers, and provides an evaluation procedure to guide clinicians applying intravenous beta-blockers to clinical practice.Keywords Beta-blockers; Acute myocardial infarction ReviewBeta-blockers are heralded as a major advance in the treatment of patients with myocardial infarction (MI). Patients without contraindications are recommended to receive intravenous administration of beta-blockers at the time of presentation for relief of ischemic pain; for the control of hypertension, sinus tachycardia and sustained ventricular tachycardia; and for the primary prevention of sudden cardiac death (Class I, Level of Evidence B) [1]. Recent data have called into question the role of beta-blockers in MI. Recommendations on the intravenous administration of beta-blockers by current guidelines are more prudent in these cases (Class IIa, Level of Evidence B) [2,3]. The use of early β-blocker therapy for patients with AMI in China is suboptimal, with underuse in patients who could benefit and substantial use among those who might be harmed [4]. The present article is a review on the efficacy and safeties of the early administration of intravenous beta-blockers examined in trials conducted in the pre-reperfusion era and reperfusion era, and provide an evaluation procedure to guide clinicians applying IV beta-blockers to clinical practice. DeathTwo large trials were conducted in the pre-reperfusion era. In the Metoprolol in Myocardial Infarction (MIAMI) trial, intravenous metoprolol followed by oral administration did not significantly reduce 15-day mortality (4.3% vs. 4.9%, P=0.29) as compared to placebo [5].In another large randomized study, the First International Study of Infarct Survival (ISIS-1) trial, there was significantly lower vascular mortality during the first seven days in the atenolol group (3.89% vs.4.57% , P<0.04) as compared to the placebo group [6]. A meta-analysis of 51 early trials of intravenous beta-blockers, administered at the time of presentation in the pre-reperfusion era, revealed a small and nonsignificant reduction in mortality. The number needed to treat (NNT) was 250 patients to avoid one death [7].Similarly, two large trials were conducted in the reperfusion era. In the Thrombolysis in Myocardial Infarction (TIMI) Phase IIB study, there was no difference in mortality neither within 6 days of entry (2.4% vs. 2.4%, P=0.98) nor within 6 weeks of entry (3.6% vs. 3.5%, P=0.91) between the immediate metoprolol intravenous and deferred groups [8]. The ClOpidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT) were to assess the balance of risks and ...

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“…This trial showed that early routine administration of IV metoprolol is not beneficial in reducing infarct size in patients with STEMI and primary PCI. 16 The Resuscitation Outcomes Consortium Amiodarone, Lidocaine, Placebo Study Antiarrhythmic drugs are usually used in out-of-hospital cardiac arrest (OHCA) with shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), although the benefits for survival of these therapies have not been MANO T et al…”

Section: Early-bamimentioning

confidence: 99%

Report of the American College of Cardiology (ACC) Scientific Sessions 2016, Chicago

Mano

Yamamoto

2016

Circ J

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Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention

Cited by 152 publications

References 23 publications

Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

Early Intravenous Beta-blockers for Acute Myocardial Infarction

Report of the American College of Cardiology (ACC) Scientific Sessions 2016, Chicago

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