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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.

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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

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