Intravenous Beta-Blockers in ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis

• Published in: International journal of cardiology 2017-02, Vol.228, p.295-302
• Main Authors: Sterling, Lee H, Filion, Kristian B., PhD, Atallah, Renee, MSc, Reynier, Pauline, MSc, Eisenberg, Mark J., MD, MPH
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Adrenergic beta-Antagonists - therapeutic use; Beta-blockers; Cardiovascular; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Electrocardiography - methods; Female; Humans; Infusions, Intravenous; Male; Meta-analysis; Percutaneous Coronary Intervention - methods; Prognosis; Randomized Controlled Trials as Topic; Severity of Illness Index; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - therapy; STEMI; Survival Analysis; Systematic review; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.11.133

Abstract Background/Objectives The role of intravenous (IV) beta-blockers in conjunction with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains unclear. We therefore conducted a meta-analysis to assess their role in the acute phase of STEMI. Methods We systematically searched the Cochrane Libraries, Medline, and EMBASE for RCTs comparing IV beta-blockers with inactive controls in STEMI patients undergoing PCI. The primary outcome was left ventricular ejection fraction (LVEF). Pooling was performed using DerSimonian and Laird random-effects models. Results Four RCTs (n = 1,149) were included in our meta-analysis. All RCTs only enrolled patients with confirmed STEMI with symptoms lasting < 6 or < 12 hours, and presenting in Killip Class 1 or 2. Mean age ranged across trials from 58.5-62.5 years. Most patients were male (range: 74.8%-86.3%). Data suggest that IV beta-blockers may improve LVEF at 0-2 weeks (weighted mean difference [WMD]: 1.9%; 95% confidence interval [CI]: -0.7%, 4.5%) and 4-6 weeks (WMD: 1.4%; 95% CI: -3.1%, 5.9%) post-infarct, reaching statistical significance at 24 weeks (WMD: 2.6%; 95% CI: 0.6%, 4.6%). Rates of ventricular arrhythmia (risk ratio [RR]: 0.65; 95% CI: 0.33, 1.29), any arrhythmia (RR: 0.67; 95% CI: 0.36, 1.27), and cardiogenic shock (RR: 0.77; 95% CI: 0.31, 1.95) during index hospitalization were numerically lower with IV beta-blockers, but 95% CIs were wide. Conclusions In STEMI patients presenting in Killip Class 1 or 2, IV beta-blockers in conjunction with PCI are associated with improved LVEF at 24 weeks relative to PCI alone.