Intracranial hemorrhage rates and effect of immediate beta-blocker use in patients with acute myocardial infarction treated with tissue plasminogen activator. Participants in the National Registry of Myocardial Infarction-2.
In acute myocardial infarction (AMI), immediate beta-blocker therapy reduces the incidence of reinfarction and recurrent chest pain in patients receiving tissue plasminogen activator (t-PA). Data from the Thrombolysis in Myocardial Infarction (TIMI)-2 trial also raises the possibility that such therapy may reduce the rate of intracranial hemorrhage (ICH). We reviewed data obtained from 60,329 patients treated with t-PA who were enrolled in the National Registry of Myocardial Infarction 2. Of the 60,329 in the study cohort, 23,749 patients (39.4%) were treated with immediate beta-blocker therapy and 542 patients (0.9%) developed an ICH. In a multivariate model that included all covariates known to be associated with the development of ICH, immediate beta-blocker therapy was associated with a 31% reduction in the ICH rate (odds ratio 0.69, 95% confidence intervals 0.57 to 0.84). Thus, in the present study, the use of immediate beta-blocker therapy in patients with AMI treated with t-PA was associated with a significant reduction in ICH. This finding supports the observations made in the TIMI 2 trial and serves to reinforce the recommendations made by the American College of Cardiology/American Heart Association task force that immediate beta-blocker therapy should be administered to all patients with AMI who do not have contraindications to this therapy.
Barron
H V
HV
Department of Medicine, University of California-San Francisco, USA. barron.hal@gene.com
Rundle
A C
AC
Gore
J M
JM
Gurwitz
J H
JH
Penney
J
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002140:California; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D008404:Massachusetts; D008824:Michigan; D009203:Myocardial Infarction / Q000188:drug therapy*; D010960:Plasminogen Activators / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
D000319:Adrenergic beta-Antagonists; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator