Early intravenous beta-blockers in patients with acute coronary syndrome-A meta-analysis of randomized trials

Saurav Chatterjee, Debanik Chaudhuri, Rajesh Vedanthan, Valentin Fuster, Borja Ibanez, Sripal Bangalore, Debabrata Mukherjee

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61 Scopus citations

Abstract

Background: Intravenous (IV) beta-blockade is currently a Class IIa recommendation in early management of patients with acute coronary syndromes (ACS) without obvious contraindications. Methods: Wesearched the PubMed, EMBASE and the Cochrane Register for Controlled Clinical Trials for randomized clinical trials from1965 through December, 2011, comparing intravenous beta-blockers administered within 12 hours of presentation of ACS with standardmedical therapy and/or placebo. The primary outcome assessed was the risk of short-term (in-hospital mortality-with maximum follow up duration of 90 days) all-cause mortality in the intervention group versus the comparator group. The secondary outcomes assessed were ventricular tachyarrhythmias, myocardial reinfarction, cardiogenic shock, and stroke. Pooled treatment effects were estimated using relative risk with Mantel-Haenszel risk ratio, using a random-effects model. Results: Sixteen studies enrolling 73,396 participantsmet the inclusion / exclusion criteria. In- hospitalmortality was reduced 8% with intravenous beta-blockers, RR=0.92 (95% CI, 0.86-1.00; p=0.04) when compared with controls. Moreover, intravenous beta-blockade reduced the risk of ventricular tachyarrhythmias (RR=0.61; 95 % CI 0.47-0.79; p=0.0003) and myocardial reinfarction (RR=0.73, 95 % CI 0.59-0.91; p=0.004) without increase in the risk of cardiogenic shock, (RR=1.02; 95% CI 0.77-1.35; p=0.91) or stroke (RR=0.58; 95 % CI 0.17-1.98; p=0.38). Conclusions: Intravenous beta-blockers early in the course of appropriate patients with ACS appears to be associated with significant reduction in the risk of short-term cardiovascular outcomes, including a reduction in the risk of all-cause mortality.

Original languageEnglish
Pages (from-to)915-921
Number of pages7
JournalInternational Journal of Cardiology
Volume168
Issue number2
DOIs
StatePublished - 30 Sep 2013

Keywords

  • Beta- Blocker
  • Cardiovascular Pharmacology
  • IV
  • Meta-analysis
  • Mortality
  • Myocardial Infarction

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