Document Detail


Does the early administration of beta-blockers improve the in-hospital mortality rate of patients admitted with acute coronary syndrome?
MedLine Citation:
PMID:  20078433     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). This was a systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS. METHODS: The authors searched the PubMed and EMBASE databases for randomized controlled trials from 1965 through May 2009 using a search strategy derived from the following PICO formulation of our clinical question: Patients included adults (18+ years) with an acute or suspected myocardial infarction (MI) within 24 hours of onset of chest pain. Intervention included intravenous or oral beta-blockers administered within 8 hours of presentation. The comparator included standard medical therapy with or without placebo versus early beta-blocker administration. The outcome was the risk of in-hospital death in the intervention groups versus the comparator groups. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. In-hospital mortality rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) between beta-blockers and controls. Statistical analysis was done with Review Manager V5.0. RESULTS: Eighteen articles (total N = 72,249) met the inclusion/exclusion criteria. For in-hospital mortality, RR = 0.95 (95% CI, 0.90-1.01). In the largest of these studies (n = 45,852), a significantly higher rate (p < 0.0001) of cardiogenic shock was observed in the beta-blocker (5.0%) versus control group (3.9%). CONCLUSIONS: This systematic review failed to demonstrate a convincing in-hospital mortality benefit for using beta-blockers early in the course of patients with an acute or suspected MI.
Authors:
Ethan Brandler; Lorenzo Paladino; Richard Sinert
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  17     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-18     Completed Date:  2010-04-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1-10     Citation Subset:  IM    
Copyright Information:
(c) 2010 by the Society for Academic Emergency Medicine
Affiliation:
Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / drug therapy*,  mortality*
Adrenergic beta-Antagonists / administration & dosage*
Angina Pectoris / drug therapy*
Bias (Epidemiology)
Drug Administration Schedule
Hospital Mortality*
Humans
Randomized Controlled Trials as Topic
Risk
Risk Assessment
Time Factors
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Comments/Corrections
Comment In:
Acad Emerg Med. 2010 Jan;17(1):93-5   [PMID:  20078441 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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