Carvedilol prevents remodeling in patients with left ventricular dysfunction after acute myocardial infarction,

Objective The aim of the study was to assess the effects of carvedilol, a vasodilating nonselective β-blocker, on the indexes of left ventricular remodeling after acute myocardial infarction in those with left ventricular dysfunction. Methods and Results Forty-nine patients with predischarge left ventricular ejection fraction <45% after acute myocardial infarction were evaluated in a double-blind, randomized, placebo-controlled, parallel group study (selected from the database of the Carvedilol Heart Attack Pilot Study: CHAPS). Patients received medication after thrombolysis and continued to do so for 6 months. Two-dimensional echocardiography was performed before discharge (7 to 10 days after admission) and at 3 months after acute myocardial infarction. Analysis of variance showed that wall thickness opposite the site of infarction decreased from (mean ± SD) 12.3 ± 2.1 mm to 11.0 ± 2.4 mm with carvedilol compared with 11.6 ± 1.9 mm to 12.2 ± 1.9 mm with placebo (P = .01). Left ventricular mass changed from 235 ± 74 g to 217 ± 64 g with carvedilol compared with 227 ± 80 g to 252 ± 85 g with placebo ( P = .02). Carvedilol prevented alteration of sphericity index (ratio of long and short axis of left ventricle) that changed from 1.65 ± 0.29 to 1.66 ± 20 with carvedilol compared with 1.58 ± 0.33 to 1.39 ± 0.19 with placebo (P = .02); alteration was also prevented of wall thickening abnormality at infarct site, which changed from 9.2 ± 3.1 cm2 to 9.1 ± 3.5 cm 2 with carvedilol compared with 10.3 ± 3.3 cm2 to 13.5 ± 4.6 cm2 with placebo (P = .002). Conclusion Carvedilol administered early after acute myocardial infarction results in attenuation of left ventricular remodeling in patients with persistent left ventricular dysfunction before discharge. (Am Heart J 1999;137;646-52.)