Beta-adrenergic blockers in patients with acute myocardial infarction.
Beta-blockers given within the first 24 hours of an acute MI, first as an intravenous bolus followed by oral therapy, have been shown to reduce in-hospital mortality following a myocardial infarction. For the long-term, beta-blockers represent the only documented effective prophylactic treatment for MI patients. The reduction in all-cause mortality is due primarily to a reduction in atherosclerotic cardiovascular deaths, particularly sudden cardiac deaths. This finding is consistent with the experimental observation that beta-blockers raise the threshold for ventricular fibrillation. Indeed, MI patients with complex ventricular arrhythmias respond very favorably to beta-blockers. However, reductions in nonsudden deaths and nonfatal reinfarctions have also been observed, suggesting that the beneficial effects of beta-blockers are not limited to antiarrhythmic effects alone and that these drugs may also have anti-ischemic effects. The prime candidates for beta-blocker therapy are the high-risk MI patients with transient electrical and/or pump complications during the acute phase. If therapy is initiated within hours of an acute infarction, it seems reasonable to continue it after hospital discharge. Evidence from the large, long-term trials suggest that, in the absence of any troublesome adverse reaction and given that most post-MI patients experience ventricular arrhythmias and angina, it seems reasonable not to limit the duration of treatment.
Furberg
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Byington
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D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D011897:Random Allocation
D000319:Adrenergic beta-Antagonists