TY - JOUR
T1 - Clinical outcomes with β-blockers for myocardial infarction
T2 - A meta-analysis of randomized trials
AU - Bangalore, Sripal
AU - Makani, Harikrishna
AU - Radford, Martha
AU - Thakur, Kamia
AU - Toklu, Bora
AU - Katz, Stuart D.
AU - Dinicolantonio, James J.
AU - Devereaux, P. J.
AU - Alexander, Karen P.
AU - Wetterslev, Jorn
AU - Messerli, Franz H.
N1 - Publisher Copyright:
© 2014 Elsevier Inc.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background: Debate exists about the efficacy of β-blockers in myocardial infarction and their required duration of usage in contemporary practice.Methods: We conducted a MEDLINE/EMBASE/CENTRAL search for randomized trials evaluating β-blockers in myocardial infarction enrolling at least 100 patients. The primary outcome was all-cause mortality. Analysis was performed stratifying trials into reperfusion-era (> 50% undergoing reperfusion or receiving aspirin/statin) or pre-reperfusion-era trials.Conclusions: In contemporary practice of treatment of myocardial infarction, β-blockers have no mortality benefit but reduce recurrent myocardial infarction and angina (short-term) at the expense of increase in heart failure, cardiogenic shock, and drug discontinuation. The guideline authors should reconsider the strength of recommendations for β-blockers post myocardial infarction.Results: Sixty trials with 102,003 patients satisfied the inclusion criteria. In the acute myocardial infarction trials, a significant interaction (Pinteraction=.02) was noted such that β-blockers reduced mortality in the prereperfusion (incident rate ratio [IRR] 0.86; 95% confidence interval [CI], 0.79-0.94) but not in the reperfusion era (IRR 0.98; 95% CI, 0.92-1.05). In the pre-reperfusion era, β-blockers reduced cardiovascular mortality (IRR 0.87; 95% CI, 0.78-0.98), myocardial infarction (IRR 0.78; 95% CI, 0.62-0.97), and angina (IRR 0.88; 95% CI, 0.82-0.95), with no difference for other outcomes. In the reperfusion era, β-blockers reduced myocardial infarction (IRR 0.72; 95% CI, 0.62-0.83) (number needed to treat to benefit [NNTB]=209) and angina (IRR 0.80; 95% CI, 0.65-0.98) (NNTB=26) at the expense of increase in heart failure (IRR 1.10; 95% CI, 1.05-1.16) (number needed to treat to harm [NNTH]=79), cardiogenic shock (IRR 1.29; 95% CI, 1.18-1.41) (NNTH 90), and drug discontinuation (IRR 1.64; 95% CI, 1.55-1.73), with no benefit for other outcomes. Benefits for recurrent myocardial infarction and angina in the reperfusion era appeared to be short term (30 days).
AB - Background: Debate exists about the efficacy of β-blockers in myocardial infarction and their required duration of usage in contemporary practice.Methods: We conducted a MEDLINE/EMBASE/CENTRAL search for randomized trials evaluating β-blockers in myocardial infarction enrolling at least 100 patients. The primary outcome was all-cause mortality. Analysis was performed stratifying trials into reperfusion-era (> 50% undergoing reperfusion or receiving aspirin/statin) or pre-reperfusion-era trials.Conclusions: In contemporary practice of treatment of myocardial infarction, β-blockers have no mortality benefit but reduce recurrent myocardial infarction and angina (short-term) at the expense of increase in heart failure, cardiogenic shock, and drug discontinuation. The guideline authors should reconsider the strength of recommendations for β-blockers post myocardial infarction.Results: Sixty trials with 102,003 patients satisfied the inclusion criteria. In the acute myocardial infarction trials, a significant interaction (Pinteraction=.02) was noted such that β-blockers reduced mortality in the prereperfusion (incident rate ratio [IRR] 0.86; 95% confidence interval [CI], 0.79-0.94) but not in the reperfusion era (IRR 0.98; 95% CI, 0.92-1.05). In the pre-reperfusion era, β-blockers reduced cardiovascular mortality (IRR 0.87; 95% CI, 0.78-0.98), myocardial infarction (IRR 0.78; 95% CI, 0.62-0.97), and angina (IRR 0.88; 95% CI, 0.82-0.95), with no difference for other outcomes. In the reperfusion era, β-blockers reduced myocardial infarction (IRR 0.72; 95% CI, 0.62-0.83) (number needed to treat to benefit [NNTB]=209) and angina (IRR 0.80; 95% CI, 0.65-0.98) (NNTB=26) at the expense of increase in heart failure (IRR 1.10; 95% CI, 1.05-1.16) (number needed to treat to harm [NNTH]=79), cardiogenic shock (IRR 1.29; 95% CI, 1.18-1.41) (NNTH 90), and drug discontinuation (IRR 1.64; 95% CI, 1.55-1.73), with no benefit for other outcomes. Benefits for recurrent myocardial infarction and angina in the reperfusion era appeared to be short term (30 days).
UR - http://www.scopus.com/inward/record.url?scp=84907998224&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84907998224&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2014.05.032
DO - 10.1016/j.amjmed.2014.05.032
M3 - Article
C2 - 24927909
AN - SCOPUS:84907998224
SN - 0002-9343
VL - 127
SP - 939
EP - 953
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 10
ER -