Is there still a role for treatment with beta-adrenoceptor antagonists in post-myocardial infarction patients with well-preserved left ventricular systolic function?
The utility of beta-adrenoceptor antagonists post myocardial infarction was established in the pre-thrombolytic era. Evidence for improvement in long-term prognosis with metoprolol, timolol and propranolol in particular derives from reduction in event rates in patients who have had substantial left ventricular damage at the time of infarction and probably correlates largely with the more recently demonstrated salutary effects of this group of drugs in patients with chronic heart failure. In all other respects, evidence for beneficial effects of beta-adrenoceptor antagonists in peri-infarct and post-infarct therapeutics is equivocal. They appear to exert no major influence on outcomes in patients with unstable angina, nor do they markedly alter early clinical course in uncomplicated acute myocardial infarction, irrespective of other interventions. Furthermore, the limited available analyses suggest no discernible beneficial effect on long-term outcomes post-uncomplicated infarction. It is possible that in such patients, current recommendations for 'routine' long-term beta-adrenoceptor blockade can no longer be justified.
Horowitz
John D
JD
Cardiology Units, The Queen Elizabeth Hospital & Lyell McEwin Hospital, The University of Adelaide, South Australia, Australia. john.horowitz@adelaide.edu.au
Arstall
Margaret A
MA
Zeitz
Christopher J
CJ
Beltrame
John F
JF
D018674:Adrenergic Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D015906:Angioplasty, Balloon, Coronary; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008790:Metoprolol / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology*; D011433:Propranolol / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013999:Timolol / Q000627:therapeutic use; D016277:Ventricular Function, Left
D018674:Adrenergic Antagonists; D013999:Timolol; D011433:Propranolol; D008790:Metoprolol