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Effect of beta-blocking therapy on outcome in the Multicenter UnSustained Tachycardia Trial (MUSTT)

Kristin E Ellison1, Gail E Hafley, Kathleen Hickey

  • 1Brown Medical School, Providence, RI, USA. kellison@lifespan.org

Circulation
|November 20, 2002
PubMed

Insights

Beta-blockers significantly reduce mortality in high-risk heart attack survivors, even with remote infarction. This survival benefit is observed across patient groups, excluding those with implantable defibrillators.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Beta-blockers are established treatments for reducing mortality and sudden death in recent myocardial infarction survivors.
  • The efficacy of beta-blockers in high-risk patients with remote myocardial infarction and ventricular tachycardia remains less clear.

Purpose of the Study:

  • To evaluate the impact of beta-blocker therapy on mortality and arrhythmic events in patients with coronary artery disease, reduced ejection fraction, and nonsustained ventricular tachycardia.
  • To determine if beta-blockers provide a survival benefit in patients with inducible sustained ventricular tachyarrhythmia.

Main Methods:

  • Analysis of 2096 patients from the Multicenter UnSustained Tachycardia Trial (MUSTT) with ejection fraction ≤40% and spontaneous nonsustained ventricular tachycardia.
  • Comparison of outcomes between patients receiving beta-blockers at hospital discharge and those not, stratified by inducible sustained ventricular tachyarrhythmia status.

Main Results:

  • Beta-blocker use was associated with significantly decreased 5-year total mortality (50% vs. 66%; adjusted P=0.0001) in the overall study population.
  • The mortality benefit was evident in patients with and without inducible tachycardia, but not in those treated with implantable defibrillators.
  • Beta-blocker therapy did not significantly affect the rate of arrhythmic death or cardiac arrest (adjusted P=0.2344).

Conclusions:

  • Beta-blocking agents demonstrate beneficial effects on survival for patients with characteristics similar to those in the MUSTT trial.
  • The survival advantage appears to be independent of a direct antiarrhythmic effect.
  • The benefits of beta-blockers were observed in all subgroups except for patients managed with implantable defibrillators.
Abstract

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