Quantitative relationship between resting heart rate reduction and magnitude of clinical benefits in post-myocardial infarction: a meta-regression of randomized clinical trials.
OBJECTIVE
The impact on mortality outcomes of beta-blockers and calcium blockers in post-myocardial infarction (MI) has been suggested to be related to resting heart rate (HR) reduction. A meta-regression of randomized clinical trials was carried out to assess this relationship using weighted meta-regression of logarithm of odds ratio against absolute HR reduction.


RESULTS
Twenty-five controlled randomized trials (21 with beta-blockers and four with calcium channel blockers) involving a total of 30 904 patients meet eligibility criteria, but only 17 documented changes in resting HR (14 with beta-blockers and three with calcium channel blockers). A statistically significant relationship was found between resting HR reduction and the clinical benefit including reduction in cardiac death (P < 0.001), all-cause death (P = 0.008), sudden death (P = 0.015), and non-fatal MI recurrence (P = 0.024). Each 10 b.p.m. reduction in the HR is estimated to reduce the relative risk of cardiac death by 30%.


CONCLUSIONS
The meta-regression of the randomized clinical trials strongly suggest that the beneficial effect of beta-blockers and calcium channel blockers in post-MI patients is proportionally related to resting HR reduction. Furthermore, the absence of residual heterogeneity indicated that resting HR reduction could be a major determinant of the clinical benefit.
Cucherat
Michel
M
Faculté de médecine Laennec, EA3736-Université Lyon 1, 11 rue Guillaume Paradin, Lyon, France. mcu@upcl.univ-lyon1.fr
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers