Pharmacological treatment during AMI and in secondary prevention: the scientific evidence

Table 4a. Betablockers. Effect on mortality.
STUDY DRUG No. PATIENTS FOLLOW-UP VAR. P
During infarction
HJALMARSON (1981) [40] METOPROLOL 1,395 3 MONTHS -36% <0.05
MIAMI (1985, 1991) [62, 63] METOPROLOL 5,778 1 YEAR -1% NS
ISIS 1 (1986) [44] ATENOLOL 16,027 1 YEAR -15% <0.04
TIMI IIB (1991) [80] METOPROLOL 1,434 1 YEAR -- NS
After infarction
NORWEGIAN STUDY (1981) [66] TIMOLOL 1,884 3 YEARS -39% <0.001
BHAT (1982) [9] PROPRANOLOL 3,873 2 YEARS -28% <0.005

 

1996 ACC/AHA GUIDELINES

  • Class I:
    • Patients without a contraindication to beta-adrenoceptor blocker therapy who can be treated within 12 hours of onset of infarction, irrespective of administration of concomitant thrombolytic therapy.
    • Patients with continuing or recurrent ischemic pain.
    • Patients with tachyarrhythmias, such as AF with a rapid ventricular response.
  • Class IIb:
    • Non-Q-wave MI.
  • Class III:
    • Patients with moderate or severe LV failure or other contraindications to beta-adrenoceptor blocker therapy.

1999 ACC/AHA GUIDELINES

  • Class I:
    • Patients without a contraindication to beta-adrenoceptor blocker therapy who can be treated within 12 hours of onset of infarction, irrespective of administration of concomitant thrombolytic therapy or performance of primary angioplasty.
  • Class IIb:
    • Patients with moderate LV failure (the presence of bibasilar rales without evidence of low cardiac output) or other relative contraindications to beta-adrenoceptor blocker therapy, provided patients can be monitored closely.
  • Class III:
    • Patients with severe LV failure.

ANMCO-SIC CLINICAL GUIDELINES

  • Type A Evidence

 

Table 4b. Betablockers. Effect on mortality, meta-analyses.
META-ANALYSES No. STUDIES No. PATIENTS VAR. P
During infarction
YUSUF (1988) [100] 28 27,000 -13% <0.001
LAU (1992) [54] 51 31,669 -12% <0.05
TEO (1993) [93] 29 28,970 -13% <0.02
After infarction
YUSUF (1988) [100] 25 23,000 -22% <0.001
LAU (1992) [54] 17 20,138 -19% <0.001
TEO (1993) [93] 26 24,298 -23% <0.001

 

Table 4c. Betablockers. Effect on reinfarct.
STUDIES DRUG No. PATIENTS FOLLOW-UP VAR. P
During infarction
HJALMARSON (1981) [40] METOPROLOL 1,395 3 MONTHS -34%
fatal infarct		 <0.05
MIAMI (1985, 1991) [62, 63] METOPROLOL 5,778 1 YEAR +1% NS
ISIS 1 (1986) [44] ATENOLOL 16,027 1 YEAR    
TIMI IIB (1991) [80] METOPROLOL 1,434 1 YEAR -- NS
After infarction
NORWEGIAN STUDY (1981) [66] TIMOLOL 1,884 3 YEARS -28% <0.001
BHAT (1982) [9] PROPRANOLOL 3,873 2 YEARS    

 

1996 ACC/AHA GUIDELINES

  • Class I:
    • All but low-risk patients without a clear contraindication to beta-adrenoceptor blocker therapy. Treatment should begin within a few days of the event (if not initiated acutely) and continue indefinitely.
  • Class IIa:
    • Low-risk patients without a clear contraindication to beta-adrenoceptor blocker therapy.
  • Class IIb:
    • none
  • ClassIII:
    • Patients with a contraindication to beta-adrenoceptor blocker therapy.

1999 ACC/AHA GUIDELINES

  • Class IIa:
    • Survivors of non-ST-elevation MI.
  • Class IIb:
    • Patients with moderate or severe LV failure or other relative contraindication to beta-adrenoceptor blocker therapy, provided patients can be monitored closely.
  • Class III:
    • no recommendation

 

Table 4d. Betablockers. Effect on reinfarct, meta-analyses.
META-ANALYSES No. STUDIES No. PATIENTS VAR. P
During infarction
YUSUF (1988) [100] 27 27,000 -18% <0.001
After infarction
YUSUF (1988) [100] 25 23,000 -27% <0.001