A population-based analysis of the class effect of β-blockers after myocardial infarction

Background Long-term treatment with β-blockers reduces mortality after acute myocardial infarction (AMI). Whether β-blockers exert a class effect is unknown. Methods We analyzed mortality after AMI in Canadian patients 65 years or older who were discharged from hospital with a diagnosis of AMI from...

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Published in:The American heart journal 2007-02, Vol.153 (2), p.224-230
Main Authors: Rinfret, Stéphane, MD, MSc, Abrahamowicz, Michal, PhD, Tu, Jack, MD, PhD, Humphries, Karin, DSc, Eisenberg, Mark J., MD, MPH, Richard, Hugues, MSc, Austin, Peter C., PhD, Pilote, Louise, MD, MPH, PhD
Format: Article
Language:English
Subjects:
Acebutolol - therapeutic use
Adrenergic beta-Antagonists - therapeutic use
Aged
Atenolol - therapeutic use
Biological and medical sciences
Cardiology. Vascular system
Cardiovascular
Coronary heart disease
Female
Heart
Humans
Male
Medical sciences
Metoprolol - therapeutic use
Myocardial Infarction - drug therapy
Myocardial Infarction - mortality
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Summary:Background Long-term treatment with β-blockers reduces mortality after acute myocardial infarction (AMI). Whether β-blockers exert a class effect is unknown. Methods We analyzed mortality after AMI in Canadian patients 65 years or older who were discharged from hospital with a diagnosis of AMI from April 1996 to March 2000. Administrative data from Quebec, Ontario, and British Columbia were merged. We compared patients prescribed with metoprolol, acebutolol, or atenolol within 90 days after discharge. Results Among 31 576 patients, 67% were prescribed with metoprolol, 24% with atenolol, and 9% with acebutolol. Clinical characteristics and proportion of days covered with a β-blocker prescription were similar across groups. Although controlling for time-dependent covariates representing current use and dosage, as well as for age, sex, congestive heart failure, and several other comorbidities, patients who filled a prescription for acebutolol (hazard ratio 0.71, 95% CI 0.62-0.81) or atenolol (hazard ratio 0.79, 95% CI 0.73-0.87) had significantly lower mortality in comparison with metoprolol. Conclusions The higher mortality observed in patients receiving metoprolol compared with those receiving atenolol or acebutolol challenges the concept of a class effect of β-blockers for secondary prevention of AMI.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2006.11.008