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Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the

H J Dargie1

  • 1Department of Cardiology, Western Infirmary, G11 2NT, Glasgow, UK. H.Dargie@bio.gla.ac.uk

Lancet (London, England)
|May 18, 2001
PubMed

Insights

Carvedilol significantly reduced all-cause and cardiovascular mortality, plus recurrent heart attacks, in patients with left-ventricular dysfunction post-myocardial infarction. These benefits complement existing evidence-based treatments.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Beta-blocker efficacy post-myocardial infarction (MI) was established before current treatments like thrombolysis and ACE inhibitors.
  • Previous trials often excluded high-risk patients, particularly those with heart failure or impaired left-ventricular function.
  • This study evaluated carvedilol in MI patients with left-ventricular dysfunction under contemporary care.

Purpose of the Study:

  • To assess the long-term effectiveness of carvedilol in reducing morbidity and mortality.
  • To investigate carvedilol's impact on patients with reduced left-ventricular ejection fraction after acute MI.
  • To determine if carvedilol offers additional benefits beyond current evidence-based therapies.

Main Methods:

  • A multicenter, randomized, placebo-controlled trial involving 1959 patients with acute MI and ejection fraction ≤40%.
  • Patients were assigned carvedilol (n=975) or placebo (n=984), with gradual dose titration.
  • The primary endpoint was a composite of all-cause mortality or cardiovascular hospital admission, with intention-to-treat analysis.

Main Results:

  • No significant difference in the primary endpoint (35% vs. 37%, HR 0.92).
  • Carvedilol significantly reduced all-cause mortality (12% vs. 15%, p=0.03) and cardiovascular mortality.
  • Lower rates of non-fatal myocardial infarctions and combined mortality/non-fatal MI were observed with carvedilol.

Conclusions:

  • Carvedilol demonstrated long-term benefits in reducing all-cause and cardiovascular mortality in post-MI patients with left-ventricular systolic dysfunction.
  • The drug also decreased the incidence of recurrent non-fatal myocardial infarctions.
  • These positive effects are additive to standard treatments for acute myocardial infarction, including ACE inhibitors.
Abstract

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