Document Detail


beta Blockade after myocardial infarction: systematic review and meta regression analysis.
MedLine Citation:
PMID:  10381708     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To assess the effectiveness of beta blockers in short term treatment for acute myocardial infarction and in longer term secondary prevention; to examine predictive factors that may influence outcome and therefore choice of drug; and to examine the clinical importance of the results in the light of current treatment.
DESIGN: Systematic review of randomised controlled trials.
SETTING: Randomised controlled trials.
SUBJECTS: Patients with acute or past myocardial infarction. Intervention: beta Blockers compared with control.
MAIN OUTCOME MEASURES: All cause mortality and non-fatal reinfarction.
RESULTS: Overall, 5477 of 54 234 patients (10.1%) randomised to beta blockers or control died. We identified a 23% reduction in the odds of death in long term trials (95% confidence interval 15% to 31%), but only a 4% reduction in the odds of death in short term trials (-8% to 15%). Meta regression in long term trials did not identify a significant reduction in effectiveness in drugs with cardioselectivity but did identify a near significant trend towards decreased benefit in drugs with intrinsic sympathomimetic activity. Most evidence is available for propranolol, timolol, and metoprolol. In long term trials, the number needed to treat for 2 years to avoid a death is 42, which compares favourably with other treatments for patients with acute or past myocardial infarction.
CONCLUSIONS: beta Blockers are effective in long term secondary prevention after myocardial infarction, but they are underused in such cases and lead to avoidable mortality and morbidity.
Authors:
N Freemantle; J Cleland; P Young; J Mason; J Harrison
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  318     ISSN:  0959-8138     ISO Abbreviation:  BMJ     Publication Date:  1999 Jun 
Date Detail:
Created Date:  1999-07-28     Completed Date:  1999-07-28     Revised Date:  2013-04-17    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1730-7     Citation Subset:  AIM; IM    
Affiliation:
Medicines Evaluation Group, Centre for Health Economics, University of York, York YO10 5DD.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use*
Humans
Myocardial Infarction / drug therapy*
Randomized Controlled Trials as Topic
Regression Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Comments/Corrections
Comment In:
ACP J Club. 2000 Jan-Feb;132(1):4
BMJ. 2000 Feb 26;320(7234):581   [PMID:  10688573 ]
BMJ. 2000 Feb 26;320(7234):581   [PMID:  10744406 ]

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