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Published on: May 28, 2019
Intravenous beta-blockers in ST-segment elevation myocardial infarction: A systematic review and meta-analysis
Lee H Sterling1, Kristian B Filion2, Renee Atallah3
1Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, QC, Canada; Faculty of Medicine, McGill University, Montreal, QC, Canada.
Insights
Intravenous beta-blockers may improve left ventricular ejection fraction (LVEF) in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). This benefit was statistically significant at 24 weeks post-infarct.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The efficacy of intravenous (IV) beta-blockers with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is not well-established.
- This meta-analysis evaluates the role of IV beta-blockers in the acute phase of STEMI.
Purpose of the Study:
- To assess the impact of IV beta-blockers combined with PCI on STEMI patients.
- To determine the effect on left ventricular ejection fraction (LVEF) and other key cardiac outcomes.
Main Methods:
- Systematic search of Cochrane Libraries, Medline, and EMBASE for relevant randomized controlled trials (RCTs).
- Included RCTs compared IV beta-blockers versus inactive controls in STEMI patients undergoing PCI.
- Primary outcome was LVEF; data pooled using DerSimonian and Laird random-effects models.
Main Results:
- Four RCTs (n=1149) involving STEMI patients (Killip Class 1 or 2, symptom duration <12 hours) were analyzed.
- IV beta-blockers showed a trend towards improved LVEF at 0-2 and 4-6 weeks, reaching statistical significance at 24 weeks (WMD: 2.6%; 95% CI: 0.6%, 4.6%).
- Numerically lower rates of ventricular arrhythmia, any arrhythmia, and cardiogenic shock were observed with IV beta-blockers, though confidence intervals were wide.
Conclusions:
- In STEMI patients (Killip Class 1 or 2), IV beta-blockers administered with PCI are linked to enhanced LVEF at 24 weeks.
- The findings suggest a potential benefit of early IV beta-blocker use in specific STEMI populations.
Background/Objectives:
The role of intravenous (IV) beta-blockers in conjunction with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains unclear. We therefore conducted a meta-analysis to assess their role in the acute phase of STEMI.
Methods:
We systematically searched the Cochrane Libraries, Medline, and EMBASE for RCTs comparing IV beta-blockers with inactive controls in STEMI patients undergoing PCI. The primary outcome was left ventricular ejection fraction (LVEF). Pooling was performed using DerSimonian and Laird random-effects models.
Results:
Four RCTs (n=1149) were included in our meta-analysis. All RCTs only enrolled patients with confirmed STEMI with symptoms lasting <6 or <12hours, and presenting in Killip Class 1 or 2. Mean age ranged across trials from 58.5-62.5years. Most patients were male (range: 74.8%-86.3%). Data suggest that IV beta-blockers may improve LVEF at 0-2weeks (weighted mean difference [WMD]: 1.9%; 95% confidence interval [CI]: -0.7%, 4.5%) and 4-6weeks (WMD: 1.4%; 95% CI: -3.1%, 5.9%) post-infarct, reaching statistical significance at 24weeks (WMD: 2.6%; 95% CI: 0.6%, 4.6%). Rates of ventricular arrhythmia (risk ratio [RR]: 0.65; 95% CI: 0.33, 1.29), any arrhythmia (RR: 0.67; 95% CI: 0.36, 1.27), and cardiogenic shock (RR: 0.77; 95% CI: 0.31, 1.95) during index hospitalization were numerically lower with IV beta-blockers, but 95% CIs were wide.
Conclusions:
In STEMI patients presenting in Killip Class 1 or 2, IV beta-blockers in conjunction with PCI are associated with improved LVEF at 24weeks relative to PCI alone.
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