| Does the early administration of beta-blockers improve the in-hospital mortality rate of patients admitted with acute coronary syndrome? | |
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MedLine Citation:
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PMID: 20078433 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Ethan Brandler; Lorenzo Paladino; Richard Sinert |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Review |
Journal Detail:
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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:
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Created Date: 2010-01-18 Completed Date: 2010-04-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9418450 Medline TA: Acad Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 1-10 Citation Subset: IM |
Copyright Information:
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(c) 2010 by the Society for Academic Emergency Medicine |
Affiliation:
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Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Adrenergic beta-Antagonists |
| Comments/Corrections | |
Comment In:
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Acad Emerg Med. 2010 Jan;17(1):93-5
[PMID:
20078441
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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