Reappraisal of β-blocker therapy in the acute and chronic post–myocardial infarction period

In patients presenting with acute myocardial infarction (MI), the early use of intravenous β-blockade followed by short-term oral administration in the absence of reperfusion therapy has shown a modest reduction in mortality. In contrast, major reductions in mortality and reinfarction have been shown when β-blockers have been used soon after an acute MI and continued long term. These benefits were observed in trials conducted in the 1970s and 1980s, before the widespread use of reperfusion therapies, antiplatelet agents, and angiotensin-converting enzyme inhibitors; those trials excluded patients with postischemic heart failure. Recently, the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial has shown a significant reduction in all-cause mortality and reinfarction in post-MI patients with systolic dysfunction, in response to carvedilol. Despite compelling evidence supporting the use of β-blockers in the post-MI setting, data published by the National Cooperative Cardiovascular Project have shown that <50% of all post-MI patients receive β-blockers as long-term therapy. It appears that post-MI patients with perceived contraindications, such as advanced age, diabetes, heart failure, peripheral vascular disease, and/or chronic pulmonary obstructive disease, may derive a substantial benefit from the use of β-blockers. Given the considerable evidence from randomized clinical trials, the use of β-blockers is recommended in all post-MI patients without a contraindication, particularly in those with left ventricular systolic dysfunction.Am J Cardiol 2004;93(suppl):21B–29B. rticle is reprinted with permission from Reviews in Cardiovascular Medicine 2003;4(suppl 3):S13–S24. ©MedReviews, LLC. All rights reserved.