Related Experiment Video
Updated: Jul 28, 2025
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Effects of Long-Term Carvedilol Therapy in Patients With ST-Segment Elevation Myocardial Infarction and Mildly
Masashi Amano1, Chisato Izumi1, Hiroki Watanabe2
1Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiology, Tenri Hospital, Nara, Japan.
Insights
Long-term carvedilol therapy after ST-segment elevation myocardial infarction (STEMI) significantly reduced cardiac events in patients with mildly reduced left ventricular ejection fraction (LVEF). This beta-blocker benefit was not observed in patients with normal LVEF.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacotherapy
Background:
- The efficacy of long-term oral beta-blocker therapy remains uncertain for ST-segment elevation myocardial infarction (STEMI) patients with mildly reduced left ventricular ejection fraction (LVEF; ≥40%).
- Previous studies have not definitively established the benefits of beta-blockers in this specific patient subgroup post-STEMI.
- Understanding the role of beta-blockers in secondary prevention after STEMI is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of long-term beta-blocker therapy in patients following STEMI who have a mildly reduced LVEF.
- To assess the impact of carvedilol on composite cardiac outcomes in STEMI patients with varying degrees of LVEF.
- To determine if beta-blocker therapy provides a significant benefit in preventing adverse cardiac events in STEMI survivors with preserved or mildly reduced LVEF.
Main Methods:
- The CAPITAL-RCT trial randomized 794 STEMI patients with successful percutaneous coronary intervention and LVEF ≥40% to receive either carvedilol or no beta-blocker.
- Patients were stratified into mildly reduced LVEF (<55%) and normal LVEF (≥55%) groups.
- Primary endpoint: composite of all-cause death, myocardial infarction, and hospitalizations for acute coronary syndrome or heart failure. Secondary endpoint: cardiac composite outcome (cardiac death, myocardial infarction, heart failure hospitalization) over a median 3.7-year follow-up.
Main Results:
- Carvedilol therapy did not significantly reduce the primary composite endpoint in either the mildly reduced or normal LVEF strata.
- A significant reduction in the cardiac composite endpoint was observed in the mildly reduced LVEF stratum (HR 0.32; P=0.047) with carvedilol compared to no beta-blocker.
- No significant benefit for the cardiac composite endpoint was found in the normal LVEF stratum (HR 1.39; P=0.43), with a significant interaction between LVEF strata (P=0.04).
Conclusions:
- Long-term carvedilol therapy may offer a significant benefit in preventing cardiac-related events for STEMI patients with mildly reduced LVEF after primary percutaneous coronary intervention.
- The findings suggest a potential role for beta-blockers in secondary prevention specifically targeting patients with borderline LVEF post-STEMI.
- Further research may be warranted to confirm these findings and elucidate the mechanisms behind the observed benefit in the mildly reduced LVEF group.
Abstract:
The benefits of long-term oral β-blocker therapy in patients with ST-segment elevation myocardial infarction (STEMI) with mildly reduced left ventricular ejection fraction (LVEF; ≥40%) are still unknown. We sought to evaluate the efficacy of β-blocker therapy in patients with STEMI with mildly reduced LVEF. In the CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in Large-Scale Randomized Controlled Trial), patients with STEMI with successful percutaneous coronary intervention with an LVEF of ≥40% were randomly assigned to carvedilol or no β-blocker therapy. Among 794 patients, 280 patients had an LVEF of <55% at baseline (mildly reduced LVEF stratum), whereas 514 patients had an LVEF of ≥55% at baseline (normal LVEF stratum). The primary end point was a composite of all-cause death, myocardial infarction, hospitalization for acute coronary syndrome, and hospitalization for heart failure, and the secondary end point was a cardiac composite outcome: a composite of cardiac death, myocardial infarction, and hospitalization for heart failure. The median follow-up period was 3.7 years. The lower risk of carvedilol therapy relative to no β-blocker therapy was not significant for the primary end point in either the mildly reduced or normal LVEF strata. However, it was significant for the cardiac composite end point in the mildly reduced LVEF stratum (0.82/100 person-years vs 2.59/100 person-years, hazard ratio 0.32 [0.10 to 0.99], p = 0.047) but not in the normal LVEF stratum (1.48/100 person-years vs 1.06/100 person-years, hazard ratio 1.39 [0.62 to 3.13], p = 0.43, p for interaction = 0.04). In conclusion, long-term carvedilol therapy in patients with STEMI with primary percutaneous coronary intervention might be beneficial for preventing cardiac-related events in those with a mildly reduced LVEF.
More Related Videos
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:22Heart Failure Drugs: β-Blockers
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:29Cardiomyopathy V: Interprofessional Care
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
01:27Coronary Artery Disease V: Interprofessional Care