Esmolol in acute ischemic syndromes

Mitchell, Rita G.; Stoddard, Marcus F.; Ben‐Yehuda, Ori; Aggarwal, Kul; Allenby, Kent; Trillo, Raul A.; Loyd, Ruth; Chang, Cheng‐Tao; Labovitz, Arthur J.

doi:10.1067/mhj.2002.126114

Cited by 16 publications

(1 citation statement)

References 17 publications

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“…The researchers also reaffirmed the setting. [44] Evidence supports that it provides effective cardiopromortality benefit of ≥-adrenoceptor antagonists seen in previous tection to patients in the midst of an acute coronary event and may trials showing a statistically significant 1-year mortality of 7.7% even limit infarct size. [45] With a half-life of approximately 9 for those taking a ≥-adrenoceptor antagonist compared with 12.6% minutes, esmolol offers the anti-ischemic properties of more tradifor those who were not (p < 0.001) [40% reduction in mortality for tional ≥-adrenoceptor antagonists while infusing, yet its effects patients with an uncomplicated MI].…”

Section: Recommendationsmentioning

confidence: 99%

Underutilization of ??-Adrenoceptor Antagonists Post-Myocardial Infarction

Gutierrez

Labovitz

2005

American Journal of Cardiovascular Drugs

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Coronary artery disease continues to be the leading cause of death in the US. Several classes of drugs available today have shown benefit in decreasing the progression of coronary artery disease and its associated symptoms. When a patient experiences an acute coronary syndrome, beta-adrenoceptor antagonists are considered one of the cornerstones of medical therapy. Over the past 25 years, trials have demonstrated morbidity and mortality benefit when this class of drugs was given early in the post-myocardial infarction period. Subsequent substantial data have confirmed their beneficial effect on outcomes in other high-risk populations such as the elderly, those with left ventricular dysfunction, peripheral vascular disease, diabetic patients, and selected patients with reactive airway disease. Several reviews of hospital discharge data revealed that beta-adrenoceptor antagonists remain significantly underutilized in patients with acute, as well as chronic coronary artery disease. Misconceptions about the adverse effects and who would benefit probably account for physician reluctance to prescribe these medications. With rare exception, the overwhelming evidence currently supports the practice of prescribing beta-adrenoceptor antagonists to all patients immediately post-myocardial infarction and therapy to be continued indefinitely.

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Section: Recommendationsmentioning

confidence: 99%

Underutilization of ??-Adrenoceptor Antagonists Post-Myocardial Infarction

Gutierrez

Labovitz

2005

American Journal of Cardiovascular Drugs

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Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event

Perez

Musini

Wright

2009

Cochrane Database of Systematic Reviews

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Nitrates reduce mortality (4-8 deaths prevented per 1000) at 2 days when administered within 24 hours of symptom onset of an acute myocardial infarction. No mortality benefit was seen when treatment continued beyond 48 hours. Mortality benefit of immediate treatment with ACE inhibitors post MI at 2 days did not reach statistical significance but the effect was significant at 10 days (2-4 deaths prevented per 1000). There is good evidence for lack of a mortality benefit with immediate or short-term treatment with beta-blockers and calcium channel blockers for acute myocardial infarction.

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Beta-blockers for suspected or diagnosed acute myocardial infarction

Feinberg

Safi

Sethi

et al. 2019

Cochrane Database of Systematic Reviews

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BackgroundCardiovascular disease is the number one cause of death globally. According to the World Health Organization, 7.4 million people died from ischaemic heart diseases in 2012, constituting 15% of all deaths. Acute myocardial infarction is caused by blockage of the blood supplied to the heart muscle. Beta-blockers are o en used in patients with acute myocardial infarction. Previous meta-analyses on the topic have shown conflicting results ranging from harms, neutral e ects, to benefits. No previous systematic review using Cochrane methodology has assessed the e ects of beta-blockers for acute myocardial infarction. ObjectivesTo assess the benefits and harms of beta-blockers compared with placebo or no intervention in people with suspected or diagnosed acute myocardial infarction. Search methodsWe searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index Expanded and BIOSIS Citation Index in June 2019. We also searched the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Turning Research into Practice, Google Scholar, SciSearch, and the reference lists of included trials and previous reviews in August 2019. Selection criteriaWe included all randomised clinical trials assessing the e ects of beta-blockers versus placebo or no intervention in people with suspected or diagnosed acute myocardial infarction. Trials were included irrespective of trial design, setting, blinding, publication status, publication year, language, and reporting of our outcomes. Data collection and analysisWe followed the Cochrane methodological recommendations. Four review authors independently extracted data. Our primary outcomes were all-cause mortality, serious adverse events according to the International Conference on Harmonization -Good Clinical Practice (ICH-GCP), and major adverse cardiovascular events (composite of cardiovascular mortality and non-fatal myocardial infarction during followup). Our secondary outcomes were quality of life, angina, cardiovascular mortality, and myocardial infarction during follow-up. Our primary time point of interest was less than three months a er randomisation. We also assessed the outcomes at maximum follow-up beyond three months. Due to risk of multiplicity, we calculated a 97.5% confidence interval (CI) for the primary outcomes and a 98% CI for the Beta-blockers for suspected or diagnosed acute myocardial infarction (Review)

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Esmolol in acute ischemic syndromes

Cited by 16 publications

References 17 publications

Underutilization of ??-Adrenoceptor Antagonists Post-Myocardial Infarction

Underutilization of ??-Adrenoceptor Antagonists Post-Myocardial Infarction

Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event

Beta-blockers for suspected or diagnosed acute myocardial infarction

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