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Do β-blockers reduce short-term mortality following acute myocardial infarction? A systematic review and meta-analysis

Published online by Cambridge University Press:  21 May 2015

Abdullah Al-Reesi ,
Nabil Al-Zadjali ,
Jeff Perry ,
Dean Fergusson ,
Mohammed Al-Shamsi ,
Majid Al-Thagafi  and
Ian Stiell
Abdullah Al-Reesi*
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Nabil Al-Zadjali
Affiliation:
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
Jeff Perry
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Dean Fergusson
Affiliation:
Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Oman
Mohammed Al-Shamsi
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Majid Al-Thagafi
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Ian Stiell
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
*
Department of Emergency Medicine, Clinical Epidemiology Unit, F6, Ottawa Health Research Institute, 1053 Carling Ave., Ottawa ON K1Y 4E9; [email protected]

Abstract

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Objective:

Acute myocardial infarction (AMI) remains a major cause of death and β-blockers are known to reduce long-term mortality in post-AMI patients. We sought to determine whether patients receiving β-blockers acutely (within 72 h) following AMI had a lower mortality rate at 6 weeks than patients receiving placebo.

Methods:

We conducted a systematic review of randomized controlled clinical trials that assessed 6-week mortality and compared β-blockers with placebo in patients randomized within the first 72 hours following AMI. We searched these databases: MEDLINE (1966–2006), EMBASE (1980–2007), Cochrane Central Register of Controlled Trials, Health Star (1966–2007), Cochrane Database for Systematic Reviews, ACP Journal Club (1991–2007), Database of Abstracts of Reviews of Effect (< 1st quarter 2007) and Conference Papers Index (1984–2007). Two blinded reviewers extracted the data and rated study quality using the Jadad score and the adequacy of allocation concealment score, which was adopted by the Cochrane group. We calculated pooled odds ratios (ORs) using a random effect model and performed sensitivity analyses to explore the stability of the overall treatment effect.

Results:

We included 18 studies (13 were rated high-quality) with 74 643 enrolled participants and had 5095 deaths. Compared with placebo, adding β-blockers to other interventions within 72 hours after AMI did not result in a statistically significant reduction in 6-week mortality (OR 0.95, 95% confidence interval [CI] 0.90–1.01). When restricted to high quality studies, the OR for 6-week mortality reduction was 0.96 (95% CI 0.91–1.02). We found similar results including studies that enrolled patients within 24 hours after AMI. However, a subgroup analysis that excluded high-risk patients with Killip class III and above showed that β-blockers resulted in a significant reduction in short-term mortality (OR 0.93, 95% CI 0.88–0.99).

Conclusion:

Acute intervention with β-blockers does not result in a statistically significant short-term survival benefit following AMI but may be beneficial for low-risk (Killip class I) patients.

Keywords

acute myocardial infarctionmortalityβ-blockers
Type
State of the Art • À la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 3 , May 2008 , pp. 215 - 223
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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