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Intravenous (IV) Beta-blockade is not routinely recommended in the early management of patients with ST-Elevation Myocardial Infarction (STEMI). We hypothesized that IV beta blockers would improve short term mortality by reducing infarct size.
PubMed and EMBASE databases were searched from 1965 through 2011. Intervention included intravenous beta-blockers within 12 hours of presentation followed by reperfusion (either fibrinolysis or PCI). The comparator included standard medical therapy and/or placebo. The outcome assessed was the risk of in-hospital all -cause mortality. In-hospital mortality rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) using a random effects model. Statistical analysis was done with Review Manager V5.1.
Eight studies (total N = 8) met the inclusion /exclusion criteria. In-hospital mortality was not reduced with IV beta-blockers administered prior to fibrinolysis (N=6), RR = 0.99 (95% CI, 0.86–1.14; p=0.86). However IV beta-blockers before PCI (N=2) showed unequivocal in-hospital mortality benefit, RR 0.49 (95% CI, 0.33–0.74; p=0.0006), without statistical heterogeneity-although evidence was available from observational studies only.
This systematic review appears to indicate an in-hospital mortality benefit with use of IV beta-blockers before PCI early in the course of appropriate patients with STEMI.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: ACS Therapy: Key Observational Data
Abstract Category: 3. Acute Coronary Syndromes: Therapy
Presentation Number: 1168-181
- 2013 American College of Cardiology Foundation