Circulation, Vol 73, 1281-1290, Copyright © 1986 by American Heart Association
CH Croft, RE Rude, N Gustafson, PH Stone, WK Poole, R Roberts, HW Strauss, DS Raabe Jr, LJ Thomas and AS Jaffe
The effects of abrupt withdrawal or continuation of beta-blockade therapy
during acute myocardial infarction were evaluated in 326 patients
participating in the Multicenter Investigation of the Limitation of Infarct
Size (MILIS). Thirty-nine patients previously receiving a beta-blocker and
randomly selected for withdrawal of beta- blockers and placebo treatment
during infarction (group 1) were compared with 272 patients previously
untreated with beta-blockers who were also randomly assigned to placebo
therapy (group 2). There were no significant differences between the two
groups in MB creatine kinase isoenzyme (15.8 +/- 10.9 vs 18.2 +/- 14.4
g-eq/m2, respectively) estimates of infarct size, radionuclide-determined
left ventricular ejection fractions within 18 hr of infarction (0.44 +/-
0.15 vs 0.47 +/- 0.16) or 10 days later (0.42 +/- 0.14 vs 0.47 +/- 0.16),
creatine kinase-determined incidence of infarct extension (13% vs 6%),
congestive heart failure (43% vs 37%), nonfatal ventricular fibrillation
(5% vs 7%), or in-hospital mortality (13% vs 9%). Patients in group 1 had
more recurrent ischemic chest pain (p = .002) within the first 24 hr after
infarction, but not thereafter. However, this did not appear to be related
to a rebound increase in systolic blood pressure, heart rate, or double
product. In a separate analysis, 20 propranolol- eligible group 1 patients
randomly selected for withdrawal of beta- blockade (group 3) were compared
with 15 patients randomly selected for continuation of prior beta-blockade
therapy (group 4). This comparison yielded similar results. These data
indicate that the beta-blockade withdrawal phenomenon is not a major
clinical problem in patients with acute myocardial infarction.
beta-Blockade therapy can be discontinued abruptly during acute myocardial
infarction if clinically indicated.
ARTICLES
Abrupt withdrawal of beta-blockade therapy in patients with myocardial infarction: effects on infarct size, left ventricular function, and hospital course
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