| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Circulation, Vol 83, 422-437, Copyright © 1991 by American Heart Association
R Roberts, WJ Rogers, HS Mueller, CT Lambrew, DJ Diver, HC Smith, JT Willerson, GL Knatterud, S Forman and E Passamani
In the Thrombolysis in Myocardial Infarction (TIMI) Phase II trial,
patients received intravenous recombinant tissue-type plasminogen activator
(rt-PA) and were randomized to either a conservative or an invasive
strategy. Within this study, the effects of immediate versus deferred
beta-blocker therapy were also assessed in patients eligible for
beta-blocker therapy, a group of 1,434 patients of which 720 were
randomized to the immediate intravenous group and 714 to the deferred
group. In the immediate intravenous group, within 2 hours of initiating
rt-PA metoprolol was given (5 mg intravenously at 2-minute intervals over 6
minutes, for a total intravenous dose of 15 mg, followed by 50 mg orally
every 12 hours in the first 24 hours and 100 mg orally every 12 hours
thereafter). The patients assigned to the deferred group received
metoprolol, 50 mg orally twice on day 6, followed by 100 mg orally twice a
day thereafter. The therapy was tolerated well in both groups and the
primary end point, resting global ejection fraction at hospital discharge,
averaged 50.5% and was virtually identical in the two groups. The regional
ventricular function was also similar in the two groups. Overall, there was
no difference in mortality between the immediate intravenous and deferred
groups, but in the subgroup defined as low risk there were no deaths at 6
weeks among those receiving immediate beta-blocker therapy in contrast to
seven deaths among those in whom beta-blocker therapy was deferred. These
findings for a secondary end point in a subgroup were not considered
sufficient to warrant a recommendation regarding clinical use. There was a
lower incidence of reinfarction (2.7% versus 5.1%, p = 0.02) and recurrent
chest pain (18.8% versus 24.1%, p less than 0.02) at 6 days in the
immediate intravenous group. Thus, in appropriate postinfarction patients,
beta-blockers are safe when given early after thrombolytic therapy and are
associated with decreased myocardial ischemia and reinfarction in the first
week but offer no benefit over late administration in improving ventricular
function or reducing mortality.
ARTICLES
Immediate versus deferred beta-blockade following thrombolytic therapy in patients with acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) II-B Study
Maryland Medical Research Institute, Baltimore 21210.
This article has been cited by other articles:
 |
|
 |
|
  P. M. Ho, P. N. Peterson, and F. A. Masoudi Evaluating the Evidence: Is There a Rigid Hierarchy? Circulation, October 14, 2008; 118(16): 1675 - 1684. [Full Text] [PDF]
|
|
|
|
 |
|
 American College of Cardiology/American Heart Asso, Developed in Collaboration With the Canadian Cardi, Endorsed by the American Academy of Family Physici, 2007 Writing Group to Review New Evidence and Upda, E. M. Antman, M. Hand, P. W. Armstrong, E. R. Bates, L. A. Green, L. K. Halasyamani, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction J. Am. Coll. Cardiol., January 15, 2008; 51(2): 210 - 247. [Full Text] [PDF]
|
|
|
|
|
|
E. M. Antman, M. Hand, P. W. Armstrong, E. R. Bates, L. A. Green, L. K. Halasyamani, J. S. Hochman, H. M. Krumholz, G. A. Lamas, C. J. Mullany, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the Canadian Cardiovascular Society Endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee Circulation, January 15, 2008; 117(2): 296 - 329. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]
|
|
|
|
|
|
S. Bangalore, F. H. Messerli, J. B. Kostis, and C. J. Pepine Cardiovascular Protection Using Beta-Blockers: A Critical Review of the Evidence J. Am. Coll. Cardiol., August 14, 2007; 50(7): 563 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): 652 - 726. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Rosendorff, H. R. Black, C. P. Cannon, B. J. Gersh, J. Gore, J. L. Izzo Jr, N. M. Kaplan, C. M. O'Connor, P. T. O'Gara, and S. Oparil REPRINT Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention Hypertension, August 1, 2007; 50(2): e28 - e55. [Full Text] [PDF]
|
|
|
|
|
|
E. R. Bates Role of Intravenous -Blockers in the Treatment of ST-Elevation Myocardial Infarction: Of Mice (Dogs, Pigs) and Men Circulation, June 12, 2007; 115(23): 2904 - 2906. [Full Text] [PDF]
|
|
|
|
|
|
C. Rosendorff, H. R. Black, C. P. Cannon, B. J. Gersh, J. Gore, J. L. Izzo Jr, N. M. Kaplan, C. M. O'Connor, P. T. O'Gara, and S. Oparil Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention Circulation, May 29, 2007; 115(21): 2761 - 2788. [Full Text] [PDF]
|
|
|
|
 |
|
 U. M. Idanpaan-Heikkila, L. Lambie, S. Mattke, V. McLaughlin, H. Palmer, and J. V. Tu Selecting indicators for the quality of cardiac care at the health system level in Organization for Economic Co-operation and Development countries Int. J. Qual. Health Care, September 1, 2006; 18(suppl_1): 39 - 44. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Massel Addition of clopidogrel to aspirin, but not early use of metoprolol, improved overall outcome in acute myocardial infarction Evid. Based Med., June 1, 2006; 11(3): 82 - 83. [Full Text] [PDF]
|
|
|
|
 |
|
 I. B. Mrdovic Is the level of evidence for the use of beta-blockers in acute myocardial infarction satisfactory enough? Eur. Heart J., January 1, 2006; 27(1): 118 - 119. [Full Text] [PDF]
|
|
|
|
|
|
Part 8: Stabilization of the Patient With Acute Coronary Syndromes Circulation, December 13, 2005; 112(24_suppl): IV-89 - IV-110. [Full Text] [PDF]
|
|
|
|
|
|
Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]
|
|
|
|
|
|
Task Force Members, J. Lopez-Sendo, K. Swedberg, J. McMurray, J. Tamargo, A. P. Maggioni, H. Dargie, M. Tendera, F. Waagstein, J. Kjekshus, et al. Expert consensus document on {beta}-adrenergic receptor blockers: The Task Force on Beta-Blockers of the European Society of Cardiology Eur. Heart J., August 1, 2004; 25(15): 1341 - 1362. [Full Text] [PDF]
|
|
|
|
|
|
R. A. Kloner and S. H. Rezkalla Cardiac protection during acute myocardial infarction: Where do we stand in 2004? J. Am. Coll. Cardiol., July 21, 2004; 44(2): 276 - 286. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Halkin, C. L. Grines, D. A. Cox, E. Garcia, R. Mehran, J. E. Tcheng, J. J. Griffin, G. Guagliumi, B. Brodie, M. Turco, et al. Impact of intravenous Beta-Blockade before primary angioplasty on survival in patients undergoing mechanical reperfusion therapy for acute myocardial infarction J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1780 - 1787. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Faxon Beta-blocker therapy and primary angioplasty: What is the controversy? J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1788 - 1790. [Full Text] [PDF]
|
|
|
|
 |
|
 M. J Everly, P. C Heaton, and R. J Cluxton Jr {beta}-Blocker Underuse in Secondary Prevention of Myocardial Infarction Ann. Pharmacother., February 1, 2004; 38(2): 286 - 293. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Silvet, F. Spencer, J. Yarzebski, D. Lessard, J. M. Gore, and R. J. Goldberg Communitywide Trends in the Use and Outcomes Associated With {beta}-Blockers in Patients With Acute Myocardial Infarction: The Worcester Heart Attack Study Arch Intern Med, October 13, 2003; 163(18): 2175 - 2183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Task Force on the Management of Acute Myocardi, F. Van de Werf, D. Ardissino, A. Betriu, D. V. Cokkinos, E. Falk, K. A.A. Fox, D. Julian, M. Lengyel, F.-J. Neumann, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation Eur. Heart J., January 1, 2003; 24(1): 28 - 66. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Braunwald Personal reflections on efforts to reduce ischemic myocardial damage Cardiovasc Res, December 1, 2002; 56(3): 332 - 338. [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Wright, G. S. Reeder, C. A. Herzog, R. C. Albright, B. A. Williams, D. L. Dvorak, W. L. Miller, J. G. Murphy, S. L. Kopecky, and A. S. Jaffe Acute Myocardial Infarction and Renal Dysfunction: A High-Risk Combination Ann Intern Med, October 1, 2002; 137(7): 563 - 570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Spencer, T. E. Meyer, J. M. Gore, and R. J. Goldberg Heterogeneity in the Management and Outcomes of Patients With Acute Myocardial Infarction Complicated by Heart Failure: The National Registry of Myocardial Infarction Circulation, June 4, 2002; 105(22): 2605 - 2610. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Ellis, S. J. Brener, A. M. Lincoff, D. J. Moliterno, P. L. Whitlow, J. P. Schneider, and E. J. Topol {beta}-Blockers Before Percutaneous Coronary Intervention Do Not Attenuate Postprocedural Creatine Kinase Isoenzyme Rise Circulation, November 27, 2001; 104(22): 2685 - 2688. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R.P Giugliano, J Llevadot, R.G Wilcox, E.P Gurfinkel, C.H McCabe, A Charlesworth, S.L Thompson, E.M Antman, E Braunwald, and for the In TIME II Investigators Geographic variation in patient and hospital characteristics, management, and clinical outcomes in ST-elevation myocardial infarction treated with fibrinolysis. Results from InTIME-II Eur. Heart J., September 2, 2001; 22(18): 1702 - 1715. [Abstract] [PDF]
|
|
|
|
 |
|
 Tackling myocardial infarction DTB, March 1, 2000; 38(3): 17 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Bednar and C. E. Gross Antiplatelet Therapy in Acute Cerebral Ischemia Stroke, April 1, 1999; 30(4): 887 - 893. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Becker, J. S. Hochman, C. P. Cannon, F. A. Spencer, S. P. Ball, M. J. Rizzo, E. M. Antman, and for the TIMI 9 Investigators Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists: Observations from the Thrombolysis and Thrombin Inhibition in Myocardial Infarction 9 Study J. Am. Coll. Cardiol., February 1, 1999; 33(2): 479 - 487. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K L Woods, D Ketley, P. F Ludman, K. Hardy, and S. O'Brien Intravenous beta blockade in acute myocardial infarction BMJ, January 30, 1999; 318(7179): 328b - 328. [Full Text]
|
|
|
|
|
|
S. S. Anand, S. Yusuf, J. Pogue, J. I. Weitz, and M. Flather Long-Term Oral Anticoagulant Therapy in Patients With Unstable Angina or Suspected Non–Q-Wave Myocardial Infarction : Organization to Assess Strategies for Ischemic Syndromes (OASIS) Pilot Study Results Circulation, September 15, 1998; 98(11): 1064 - 1070. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Gottlieb, R. J. McCarter, and R. A. Vogel Effect of Beta-Blockade on Mortality among High-Risk and Low-Risk Patients after Myocardial Infarction N. Engl. J. Med., August 20, 1998; 339(8): 489 - 497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H Mehta and K. A Eagle Fortnightly review: Secondary prevention in acute myocardial infarction BMJ, March 14, 1998; 316(7134): 838 - 842. [Full Text]
|
|
|
|
|
|
S. Basu, R. Senior, U. Raval, R. van der Does, T. Bruckner, and A. Lahiri Beneficial Effects of Intravenous and Oral Carvedilol Treatment in Acute Myocardial Infarction : A Placebo-Controlled, Randomized Trial Circulation, July 1, 1997; 96(1): 183 - 191. [Abstract] [Full Text]
|
|
|
|
|
|
C. H. Hennekens, C. M. Albert, S. L. Godfried, J. M. Gaziano, and J. E. Buring Adjunctive Drug Therapy of Acute Myocardial Infarction -- Evidence from Clinical Trials N. Engl. J. Med., November 28, 1996; 335(22): 1660 - 1668. [Full Text] [PDF]
|
|