Immediate beta-Blockade in Patients With Myocardial Infarctions: Is There Evidence of Benefit?
Ann Emerg Med. 2010 May 19;
Authors: Sinert R, Newman DH, Brandler E, Paladino L
STUDY OBJECTIVE: The American Heart Association recommends the initiation of beta-blockade to all patients with an ST-segment elevation myocardial infarction (STEMI) without contraindications to beta-blocking agents. The present study seeks to systematically review the medical literature to determine the efficacy of treating STEMI patients with a beta-blocker within the first 24 hours. METHODS: We searched databases for articles through MEDLINE with the PubMed interface and from 1966 through May 2009 and EMBASE from 1980 to August 2009 with the Ovid Technologies interface, using a search strategy derived from the following PICO (Patient-Intervention-Comparator-Outcome) clinical question: In patients presenting with STEMI (P), does immediate treatment with beta-blockers (I) followed by standardized care beginning on day 2 or 3 compared with placebo or no treatment followed by standardized care on day 2 or 3 (C) reduce the risk of death, reinfarction, or cardiogenic shock (O)? The methodological quality of the studies was assessed. RESULTS: From more than 2,000 references identified in the search, only a single randomized trial met the inclusion criteria. There were no statistically significant differences in mortality; the relative risk for the combined endpoint (mortality and reinfarction) was 0.67 (95% confidence interval 0.44 to 1.03) at 6 days and 0.74 (95% confidence interval 0.53 to 1.06) at 6 weeks. Outcomes for cardiogenic shock were not reported. CONCLUSION: Evidence from a single randomized trial failed to demonstrate a reduction in mortality or reinfarction with administration of beta-blocker within the first 24 hours after STEMI.
PMID: 20493586 [PubMed - as supplied by publisher]