Clinical outcome of acute myocardial infarction in patients on treatment with beta-blockers or calcium antagonists. A study of 7,922 hospitalized first myocardial infarctions.
To assess the effects of current treatments with beta-blockers or calcium antagonists on the clinical outcome of acute myocardial infarction (MI), enzymatically estimated infarct sizes, circulatory arrests from ventricular tachyarrhythmias, ventricular tachycardia (VT)/ventricular fibrillation (VF), and in-hospital mortality were analyzed retrospectively from 7,922 citizens of Malmö, Sweden, hospitalized due to a first MI between 1973 and 1987. Of these patients, 296 were on treatment with calcium antagonists, 393 on treatment with a beta 1-selective beta-blocker, 482 with a nonselective beta-blocker, and 95 on combined treatment with beta-blockers and calcium antagonists at the time of admission to hospital. In a set of multivariate analyses including several clinical characteristics, patients on treatment with a nonselective beta-blocker had a significantly lower peak aspartate aminotransferase (ASAT; difference -0.70 mukat/l, 95% CL: -1.24 to -0.16), whereas no significant relations between peak ASAT and treatment with cardioselective beta-blockers or calcium antagonists were found. Treatment with cardioselective beta-blockers or calcium antagonists, in contrast to treatment with a nonselective beta-blocker, were significant predictors of the occurrence of circulatory arrests from VT/VF. The relative risk of VT/VF in patients on cardioselective beta-blockers was 1.51 (95% CI: 1.12-2.03), and in patients on calcium antagonists 1.44 (95% CI: 1.03-2.02). None of the treatments were significantly associated with in-hospital mortality. In patients on beta-blockers or calcium antagonists when suffering their first MI, nonselective beta-blockade may reduce infarct size. Treatment with beta-blockers or calcium antagonists identified patients with an increased risk of circulatory arrests from VT/VF, but neither of the treatments were significantly associated with in-hospital mortality. We suggest that only minor differences exist between the effects of chronic treatment with beta-blockers and calcium antagonists on the outcome of an acute MI.
Section of Cardiology, Malmö General Hospital, Sweden.
O
O
Hansen
B W
BW
Johansson
B
B
Gullberg
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D017180:Tachycardia, Ventricular / Q000401:mortality
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D011188:Potassium