Effect of beta-blocking therapy on outcome in the Multicenter UnSustained Tachycardia Trial (MUSTT).
BACKGROUND
Beta-blockers are known to reduce total mortality and sudden death in survivors of recent myocardial infarction. The effects of these agents in patients at high risk for sudden death with remote infarction are not clear.


RESULTS
We analyzed the effect of beta-blockers on outcomes in 2096 patients with coronary artery disease, ejection fraction < or =40%, and spontaneous nonsustained ventricular tachycardia enrolled in the Multicenter UnSustained Tachycardia Trial (MUSTT). Forty-five percent of 702 patients with inducible sustained ventricular tachyarrhythmia and 35% of 1394 patients without inducible tachycardia were discharged from hospital receiving beta-blockers. Patients treated with beta-blockers were younger and had higher ejection fractions, higher rates of recent angina, and more recent infarction. beta-Blockers were associated with decreased total mortality for the entire study population (5-year mortality 50% with beta-blockers versus 66% without beta-blockers; adjusted P=0.0001). The mortality benefit associated with beta-blockers was present in patients with and without inducible tachycardia, except those treated with implantable defibrillators. There was no significant effect of beta-blocker therapy on the rate of arrhythmic death or cardiac arrest (adjusted P=0.2344).


CONCLUSIONS
beta-Blocking agents have beneficial effects on survival of patients having characteristics of those enrolled in the MUSTT trial. These effects do not appear to be due to a specific antiarrhythmic effect of beta-blockers. The beneficial effects of beta-blockers were demonstrable in all patients except those treated with implantable defibrillators.
Ellison
Kristin E
KE
Brown Medical School, Providence, RI, USA. kellison@lifespan.org
Hafley
Gail E
GE
Hickey
Kathleen
K
Kellen
Joyce
J
Coromilas
James
J
Stein
Kenneth M
KM
Lee
Kerry L
KL
Buxton
Alfred E
AE
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002170:Canada; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013318:Stroke Volume; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014481:United States
D000319:Adrenergic beta-Antagonists