Mortality and reinfarction among patients using different beta-blockers for secondary prevention after a myocardial infarction.
OBJECTIVE
To study differences in the clinical efficacy of various brands of beta-blocker in secondary prevention after a myocardial infarction (MI).


METHODS
All patients hospitalized with a first MI between 1995 and 2002 who were still alive 30 days after discharge and had had at least one prescription for a beta-blocker filled were identified by individual-level linkage of nationwide registries of hospitalizations and drugs dispensed from pharmacies. A total of 32,259 MI patients were included in the study. Multivariable Cox proportional hazard models were used to analyze the risks of death and recurrent MI related to treatment with different beta-blockers.


RESULTS
The risks for death and recurrent MI were similar in patients using different beta-blockers, except that mortality from all causes among patients with a prescription for sotalol was higher. Subgroup analyses of high-risk patients with diabetes or congestive heart failure and of patients using comparable dosages of beta-blockers did not show effects on the risk of death or recurrent MI.


CONCLUSIONS
Except for sotalol, the different types of beta-blocker had similar clinical efficacy in reducing mortality and the recurrence of MI. The equivalent efficacy remained when high-risk patients were analyzed separately.
Andersen
Søren Skøtt
SS
Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, Copenhagen, Denmark. ssa@heart.dk
Hansen
Morten Lock
ML
Gislason
Gunnar H
GH
Folke
Fredrik
F
Schramm
Tina Ken
TK
Fosbøl
Emil
E
Sørensen
Rikke
R
Rasmussen
Søren
S
Abildstrøm
Steen Z
SZ
Madsen
Mette
M
Køber
Lars
L
Torp-Pedersen
Christian
C
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001262:Atenolol / Q000627:therapeutic use; D017298:Bisoprolol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008790:Metoprolol / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D013015:Sotalol / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D001262:Atenolol; D013015:Sotalol; D008790:Metoprolol; D017298:Bisoprolol