Do β-blockers reduce short-term mortality following acute myocardial infarction? A systematic review and meta-analysis

Abdullah Al-Reesi, Nabil Al-Zadjali, Jeff Perry, Dean Fergusson, Mohammed Al-Shamsi, Majid Al-Thagafi, Ian Stiell

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

Objective: Acute myocardial infarction (AMI)remains a major cause of death and β-blockers are known to reduce long-term mortality in post-AMI patients, We sought to determine whether patients receiving β-blockers acutely (within 72 h) following AMI had a lower mortality rate at 6 weeks than patients receiving placebo. Methods: We conducted a systematic review of randomized controlled clinical trials that assessed 6 - week mortality and compared β-blockers with placebo in patients randomized within the first 72 hours following AMI. We searched these databases: MEDLINE (1966-2006), EMBASE (1980-2007), Cochrane Central Register of Controlled Trials, Health Star (1966-2007), Cochrane Database for Systematic Reviews, ACP Journal Club (1991-2007), Database of Abstracts of Reviews of Effect (< 1st quarter 2007) and Conference Papers Index (1984-2007). Two blinded reviewers extracted the data and rated study quality using the Jadad score and the adequacy of allocation concealment score, which was adopted by the Cochrane group. We calculated pooled odds ratios (ORs) using a random effect model and performed sensitivity analyses to explore the stability of the overall treatment effect. Results: We included 18 studies (13 were rated high-quality) with 74 643 enrolled participants and had 5095 deaths. Compared with placebo, adding β-blockers to other interventions within 72 hours after AMI did not result in a statistically significant reduction in 6-week mortality (OR 0.95, 95% confidence interval [CI] 0,90-1.01). When restricted to high quality studies, the OR for 6-week mortality reduction was 0.96 (95% CI 0.91-1.02). We found similar results including studies that enrolled patients within 24 hours after AMI. However, a subgroup analysis that excluded high-risk patients with Killip class III and above showed that β-blockers resulted in a significant reduction in short-term mortality (OR 0.93, 95% CI 0.88-0.99). Conclusion: Acute intervention with β-blockers does not result in a statistically significant short-term survival benefit following AMI but may be beneficial for low-risk (Killip class I) patients.

Original languageEnglish
Pages (from-to)215-223
Number of pages9
JournalCanadian Journal of Emergency Medicine
Volume10
Issue number3
Publication statusPublished - May 2008

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Meta-Analysis
Myocardial Infarction
Mortality
Odds Ratio
Placebos
Databases
Confidence Intervals
MEDLINE
Cause of Death
Randomized Controlled Trials
Survival
Health

Keywords

  • β-blockers
  • Acute myocardial infarction
  • Mortality

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Al-Reesi, A., Al-Zadjali, N., Perry, J., Fergusson, D., Al-Shamsi, M., Al-Thagafi, M., & Stiell, I. (2008). Do β-blockers reduce short-term mortality following acute myocardial infarction? A systematic review and meta-analysis. Canadian Journal of Emergency Medicine, 10(3), 215-223.

Do β-blockers reduce short-term mortality following acute myocardial infarction? A systematic review and meta-analysis. / Al-Reesi, Abdullah; Al-Zadjali, Nabil; Perry, Jeff; Fergusson, Dean; Al-Shamsi, Mohammed; Al-Thagafi, Majid; Stiell, Ian.

In: Canadian Journal of Emergency Medicine, Vol. 10, No. 3, 05.2008, p. 215-223.

Research output: Contribution to journalReview article

Al-Reesi, A, Al-Zadjali, N, Perry, J, Fergusson, D, Al-Shamsi, M, Al-Thagafi, M & Stiell, I 2008, 'Do β-blockers reduce short-term mortality following acute myocardial infarction? A systematic review and meta-analysis', Canadian Journal of Emergency Medicine, vol. 10, no. 3, pp. 215-223.
Al-Reesi, Abdullah ; Al-Zadjali, Nabil ; Perry, Jeff ; Fergusson, Dean ; Al-Shamsi, Mohammed ; Al-Thagafi, Majid ; Stiell, Ian. / Do β-blockers reduce short-term mortality following acute myocardial infarction? A systematic review and meta-analysis. In: Canadian Journal of Emergency Medicine. 2008 ; Vol. 10, No. 3. pp. 215-223.
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abstract = "Objective: Acute myocardial infarction (AMI)remains a major cause of death and β-blockers are known to reduce long-term mortality in post-AMI patients, We sought to determine whether patients receiving β-blockers acutely (within 72 h) following AMI had a lower mortality rate at 6 weeks than patients receiving placebo. Methods: We conducted a systematic review of randomized controlled clinical trials that assessed 6 - week mortality and compared β-blockers with placebo in patients randomized within the first 72 hours following AMI. We searched these databases: MEDLINE (1966-2006), EMBASE (1980-2007), Cochrane Central Register of Controlled Trials, Health Star (1966-2007), Cochrane Database for Systematic Reviews, ACP Journal Club (1991-2007), Database of Abstracts of Reviews of Effect (< 1st quarter 2007) and Conference Papers Index (1984-2007). Two blinded reviewers extracted the data and rated study quality using the Jadad score and the adequacy of allocation concealment score, which was adopted by the Cochrane group. We calculated pooled odds ratios (ORs) using a random effect model and performed sensitivity analyses to explore the stability of the overall treatment effect. Results: We included 18 studies (13 were rated high-quality) with 74 643 enrolled participants and had 5095 deaths. Compared with placebo, adding β-blockers to other interventions within 72 hours after AMI did not result in a statistically significant reduction in 6-week mortality (OR 0.95, 95{\%} confidence interval [CI] 0,90-1.01). When restricted to high quality studies, the OR for 6-week mortality reduction was 0.96 (95{\%} CI 0.91-1.02). We found similar results including studies that enrolled patients within 24 hours after AMI. However, a subgroup analysis that excluded high-risk patients with Killip class III and above showed that β-blockers resulted in a significant reduction in short-term mortality (OR 0.93, 95{\%} CI 0.88-0.99). Conclusion: Acute intervention with β-blockers does not result in a statistically significant short-term survival benefit following AMI but may be beneficial for low-risk (Killip class I) patients.",
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AU - Al-Shamsi, Mohammed

AU - Al-Thagafi, Majid

AU - Stiell, Ian

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N2 - Objective: Acute myocardial infarction (AMI)remains a major cause of death and β-blockers are known to reduce long-term mortality in post-AMI patients, We sought to determine whether patients receiving β-blockers acutely (within 72 h) following AMI had a lower mortality rate at 6 weeks than patients receiving placebo. Methods: We conducted a systematic review of randomized controlled clinical trials that assessed 6 - week mortality and compared β-blockers with placebo in patients randomized within the first 72 hours following AMI. We searched these databases: MEDLINE (1966-2006), EMBASE (1980-2007), Cochrane Central Register of Controlled Trials, Health Star (1966-2007), Cochrane Database for Systematic Reviews, ACP Journal Club (1991-2007), Database of Abstracts of Reviews of Effect (< 1st quarter 2007) and Conference Papers Index (1984-2007). Two blinded reviewers extracted the data and rated study quality using the Jadad score and the adequacy of allocation concealment score, which was adopted by the Cochrane group. We calculated pooled odds ratios (ORs) using a random effect model and performed sensitivity analyses to explore the stability of the overall treatment effect. Results: We included 18 studies (13 were rated high-quality) with 74 643 enrolled participants and had 5095 deaths. Compared with placebo, adding β-blockers to other interventions within 72 hours after AMI did not result in a statistically significant reduction in 6-week mortality (OR 0.95, 95% confidence interval [CI] 0,90-1.01). When restricted to high quality studies, the OR for 6-week mortality reduction was 0.96 (95% CI 0.91-1.02). We found similar results including studies that enrolled patients within 24 hours after AMI. However, a subgroup analysis that excluded high-risk patients with Killip class III and above showed that β-blockers resulted in a significant reduction in short-term mortality (OR 0.93, 95% CI 0.88-0.99). Conclusion: Acute intervention with β-blockers does not result in a statistically significant short-term survival benefit following AMI but may be beneficial for low-risk (Killip class I) patients.

AB - Objective: Acute myocardial infarction (AMI)remains a major cause of death and β-blockers are known to reduce long-term mortality in post-AMI patients, We sought to determine whether patients receiving β-blockers acutely (within 72 h) following AMI had a lower mortality rate at 6 weeks than patients receiving placebo. Methods: We conducted a systematic review of randomized controlled clinical trials that assessed 6 - week mortality and compared β-blockers with placebo in patients randomized within the first 72 hours following AMI. We searched these databases: MEDLINE (1966-2006), EMBASE (1980-2007), Cochrane Central Register of Controlled Trials, Health Star (1966-2007), Cochrane Database for Systematic Reviews, ACP Journal Club (1991-2007), Database of Abstracts of Reviews of Effect (< 1st quarter 2007) and Conference Papers Index (1984-2007). Two blinded reviewers extracted the data and rated study quality using the Jadad score and the adequacy of allocation concealment score, which was adopted by the Cochrane group. We calculated pooled odds ratios (ORs) using a random effect model and performed sensitivity analyses to explore the stability of the overall treatment effect. Results: We included 18 studies (13 were rated high-quality) with 74 643 enrolled participants and had 5095 deaths. Compared with placebo, adding β-blockers to other interventions within 72 hours after AMI did not result in a statistically significant reduction in 6-week mortality (OR 0.95, 95% confidence interval [CI] 0,90-1.01). When restricted to high quality studies, the OR for 6-week mortality reduction was 0.96 (95% CI 0.91-1.02). We found similar results including studies that enrolled patients within 24 hours after AMI. However, a subgroup analysis that excluded high-risk patients with Killip class III and above showed that β-blockers resulted in a significant reduction in short-term mortality (OR 0.93, 95% CI 0.88-0.99). Conclusion: Acute intervention with β-blockers does not result in a statistically significant short-term survival benefit following AMI but may be beneficial for low-risk (Killip class I) patients.

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