| According to MIAMI and ISIS-I trials, can a general recommendation be given for beta blockers in acute myocardial infarction? | |
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MedLine Citation:
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PMID: 2908718 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The goal of early intervention of acute coronary occlusion by beta blockers is to reduce ultimate infarct size and to consequently reduce morbidity and mortality. Until 1986 small early intervention trials suggested that infarct size may be reduced by 25% if treatment was started within 6 to 10 hours after the onset of symptoms. At this time, an average of 80% of the infarct is fully developed. On the basis of previous trials, the reduction of infarct size has been associated with improvement of symptoms, prevention of infarct development, reduced occurrence of arrhythmias and reinfarctions, and earlier discharge from the hospital. Although the trials suggested some benefit in mortality, this issue has not been solved. The MIAMI trial randomized 5778 patients to blind treatment with metoprolol or placebo. ISIS-I randomized 16,027 patients to atenolol with an open label. No titration of the effect on lowering myocardial oxygen requirement was attempted. Both studies included less than 25% of all eligible patients. Exclusions were chiefly due to current beta blocker or calcium blocker treatment. Thus, the results obtained concern only a selected group of patients. In MIAMI only 15% received treatment within 6 hours, while in ISIS 38% were treated within 4 hours. It is therefore likely that in most patients the infarcts were completed before intervention was started. Thus, the two trials did not differentiate between primary and secondary effects on the acute myocardial infarct. Mortality was reduced by 13% (NS) and 15% (p less than 0.04), respectively, in MIAMI and ISIS.(ABSTRACT TRUNCATED AT 250 WORDS) |
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Authors:
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J K Kjekshus |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy Volume: 2 ISSN: 0920-3206 ISO Abbreviation: Cardiovasc Drugs Ther Publication Date: 1988 May |
Date Detail:
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Created Date: 1991-04-26 Completed Date: 1991-04-26 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8712220 Medline TA: Cardiovasc Drugs Ther Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 113-9 Citation Subset: IM |
Affiliation:
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Department of Medicine, Baerum Hospital, Baerum Sykehus, Norway. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adrenergic beta-Antagonists / therapeutic use* Clinical Trials as Topic Humans Myocardial Infarction / drug therapy*, physiopathology |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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