Document Detail


Post-myocardial infarction beta-blocker therapy: the bradycardia conundrum. Rationale and design for the Pacemaker & beta-blocker therapy post-MI (PACE-MI) trial.
MedLine Citation:
PMID:  18294477     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Multiple clinical trials have demonstrated beta-blockers improving survival after myocardial infarction (MI). Patients with "bradycardia-related" contraindications to beta-blockers, such as those with asymptomatic bradycardia or AV conduction abnormalities, have been excluded from clinical trials of beta-blockers and continue to be excluded from post-MI beta-blocker therapy in routine clinical practice. These patients tend to be elderly and have a high 1-year mortality. If beta-blockers provide benefit to the post-MI patient independent of their heart rate-lowering effect, then these patients could benefit substantially from initiation of beta-blocker therapy. However, in this particular group of patients, beta-blockers can be safely initiated only if more severe or significant bradycardia can be prevented by pacemaker implantation. It is unclear whether adverse effects related to pacemaker implantation could also negate some or all of the hypothesized benefit of beta-blocker therapy. Although beta-blockers are particularly effective in the elderly, the benefit of beta-blocker therapy in patients with bradycardia-related contraindications to beta-blockers has not been established. The PACE-MI trial is a randomized controlled trial that will address whether beta-blocker therapy enabled by pacemaker implantation is superior to no beta-blocker and no pacemaker therapy after MI in patients with rhythm contraindications to beta-blockers or in those who have developed symptomatic bradycardia due to beta-blockers. The trial will randomize 1124 patients to standard therapy (not to include beta-blockers as patients must have a contraindication to be enrolled) or standard therapy plus pacemaker implantation and beta-blocker. The primary end point is the composite end point of total mortality plus nonfatal reinfarction.
Authors:
Jeffrey J Goldberger; Robert O Bonow; Michael Cuffe; Alan Dyer; Philip Greenland; Yves Rosenberg; Robert O'Rourke; Prediman K Shah; Sidney Smith
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2008-01-31
Journal Detail:
Title:  American heart journal     Volume:  155     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-25     Completed Date:  2008-03-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  455-64     Citation Subset:  AIM; IM    
Affiliation:
Bluhm Cardiovascular Center and the Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. j-goldberger@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use*
Bradycardia / etiology,  therapy*
Cardiac Pacing, Artificial / methods*
Heart Rate / physiology
Humans
Myocardial Infarction / complications*,  therapy
Randomized Controlled Trials as Topic / methods*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
5U01HL080416/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists

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


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