Intravenous beta-blockers in ST-segment elevation myocardial infarction: A systematic review and meta-analysis

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• 作者：Lee H. Sterling^a ; ^b ; Kristian B. Filion^a ; ^b ; ^c ; ¹ ; Renee Atallah^a ; Pauline Reynier^a ; Mark J. Eisenberg^a ; ^b ; ^c ; ^d ; ^{mark.eisenberg@mcgill.ca}
• 关键词：Beta-blockers ; STEMI ; Acute coronary syndromes ; Systematic review ; Meta-analysis
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：295-302
• 全文大小：770 K
• 卷排序：228

文摘

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.MethodsWe 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.ResultsFour RCTs (n = 1149) 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.ConclusionsIn 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.