title: Intravenous β-blockers for patients undergoing primary percutaneous coronary intervention: A meta-analysis of randomized trials.
abstract: BACKGROUND
  The efficacy and safety of intravenous β-blockers in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are not well known.
  
  
  METHODS
  Electronic databases were searched for randomized trials that compared intravenous β-blocker use with routine care or placebo in patients with STEMI undergoing primary PCI. Summary estimates risk ratios (RR) were constructed using DerSimonian and Laird model.
  
  
  RESULTS
  Four randomized trials with 1149 Killip class I or II STEMI patients were included. Intravenous β-blockers were associated with a reduction in the risk of ventricular arrhythmias during hospitalization (RR 0.42, 95% confidence interval [CI] 0.26-0.69, P=0.001). The risk of cardiogenic shock (RR 0.78, 95% CI 0.31-1.97, P=0.61), bradycardia (RR 1.54, 95% CI 0.35-6.81, P=0.57), all-cause mortality (RR 0.71, 95% CI 0.19-3.17, P=0.72), and cardiovascular mortality (RR 0.93, 95% CI 0.35-2.48, P=0.88) during hospitalization was similar in both groups. There was a trend towards a lower risk of future heart failure hospitalizations with intravenous β-blockers (RR 0.32, 95% CI 0.10-1.05, P=0.06).
  
  
  CONCLUSIONS
  Intravenous β-blockers, in STEMI patients (Killip class I or II) undergoing primary PCI, appear to be safe. Intravenous β-blockers were associated with a reduced risk of ventricular arrhythmias. Due to the small number of patients, the impact on other outcomes could not be determined. Therefore, future trials are recommended to establish the efficacy of intravenous β-blockers in primary PCI.
authors: Department of Medicine, University of Florida, Gainesville, FL, USA. Electronic address: Islam.elgendy@medicine.ufl.edu.
authors: Islam Y
authors: IY
authors: Elgendy
authors: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors: Akram Y
authors: AY
authors: Elgendy
authors: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors: Ahmed N
authors: AN
authors: Mahmoud
authors: Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA.
authors: Hend
authors: H
authors: Mansoor
authors: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors: Mohammad K
authors: MK
authors: Mojadidi
authors: Department of Medicine, University of Florida, Gainesville, FL, USA; North Florida/South, Georgia Veterans Health System, Gainesville, FL, USA.
authors: Anthony A
authors: AA
authors: Bavry
mesh_terms: D061605:Administration, Intravenous; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Adrenergic beta-antagonists; Meta-analysis; Myocardial infarction; Percutaneous coronary intervention