Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Aug;9(5):469-477.
doi: 10.1177/2048872619830609. Epub 2019 Feb 14.

Early intravenous beta-blockers in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: A patient-pooled meta-analysis of randomized clinical trials

Niels Pg Hoedemaker  1 , Vincent Roolvink  2 , Robbert J de Winter  1 , Niels van Royen  3 , Valentin Fuster  4   5 , José M García-Ruiz  5   6 , Fikret Er  7 , Natig Gassanov  7 , Kenji Hanada  8 , Ken Okumura  9 , Borja Ibáñez  5   6   10 , Arnoud W van 't Hof  11 , Peter Damman  3
Affiliations
Review

Early intravenous beta-blockers in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: A patient-pooled meta-analysis of randomized clinical trials

Niels Pg Hoedemaker et al. Eur Heart J Acute Cardiovasc Care. 2020 Aug.

Abstract

Background: Conflicting evidence is available on the efficacy and safety of early intravenous beta-blockers before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. We performed a patient-pooled meta-analysis of trials comparing early intravenous beta-blockers with placebo or routine care in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Aim: The aim of this study was to evaluate the clinical and safety outcomes of intravenous beta-blockers in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Methods: Four randomized trials with a total of 1150 patients were included. The main outcome was one-year death or myocardial infarction. Secondary outcomes included biomarker-based infarct size, left ventricular ejection fraction during follow-up, ventricular tachycardia, and a composite safety outcome (cardiogenic shock, symptomatic bradycardia, or hypotension) during hospitalization.

Results: One-year death or myocardial infarction was similar among beta-blocker (4.2%) and control patients (4.4%) (hazard ratio: 0.96 (95% confidence interval: 0.53-1.75, p=0.90, I2=0%). No difference was observed in biomarker-based infarct size. One-month left ventricular ejection fraction was similar, but left ventricular ejection fraction at six months was significantly higher in patients treated with early intravenous beta-blockade (52.8% versus 50.0% in the control group, p=0.03). No difference was observed in the composite safety outcome or ventricular tachycardia during hospitalization.

Conclusion: In ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention, the administration of early intravenous beta-blockers was safe. However, there was no difference in the main outcome of one-year death or myocardial infarction with early intravenous beta-blockers. A larger clinical trial is warranted to confirm the definitive efficacy of early intravenous beta-blockers.

Keywords: ST-segment elevation myocardial infarction; beta-blockers; intravenous beta-blockers; outcomes; primary percutaneous coronary intervention.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow diagram of trial selection. PCI: percutaneous coronary intervention.
Figure 2.
Figure 2.
Forest plot of one-year death or myocardial infarction (MI) after early intravenous beta-blockers versus control. BEAT-MI: BEtA-Blocker Therapy in Acute Myocardial Infarction; CI: confidence interval; EARLY-BMI: Early Beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction; HR: hazard ratio; METOCARD-CNIC: Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction.
Figure 3.
Figure 3.
Kaplan-Meier estimates of the cumulative one-year death or myocardial infarction (MI). CI: confidence interval; HR: hazard ratio.
See this image and copyright information in PMC

References

    1. Damman P, Beijk MA, Kuijt WJ, et al. Multiple biomarkers at admission significantly improve the prediction of mortality in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. J Am Coll Cardiol 2011; 57: 29–36. - PubMed
    1. Stone GW, Selker HP, Thiele H, et al. Relationship between infarct size and outcomes following primary PCI: Patient-level analysis from 10 randomized trials. J Am Coll Cardiol 2016; 67: 1674–1683. - PubMed
    1. Rasmussen MM, Reimer KA, Kloner RA, et al. Infarct size reduction by propranolol before and after coronary ligation in dogs. Circulation 1977; 56: 794–798. - PubMed
    1. Elgendy IY, Elgendy AY, Mahmoud AN, et al. Intravenous beta-blockers for patients undergoing primary percutaneous coronary intervention: A meta-analysis of randomized trials. Int J Cardiol 2016; 223: 891–897. - PubMed
    1. Er F, Dahlem KM, Nia AM, et al. Randomized control of sympathetic drive with continuous intravenous esmolol in patients with acute ST-segment elevation myocardial infarction: The BEtA-Blocker Therapy in Acute Myocardial Infarction (BEAT-AMI) Trial. JACC Cardiovasc Interv 2016; 9: 231–240. - PubMed

MeSH terms

Substances