Abstract 15855: Cardiovascular Benefits of Beta Blocker Therapy in Patients With Acute Coronary Syndrome Without Heart Failure: A Meta-Analysis of Randomized Controlled Trials
Background: Current guidelines recommend early use of beta blockers in acute coronary syndrome (ACS). Beta blocker therapy in ACS with previous heart failure (HF) is well established but benefit of beta blockers in ACS without previous HF is not clear. The trials of beta blockers in this setting have yielded mixed results. We performed a meta-analysis to evaluate the benefits of beta blockers in ACS patients without HF.
Methods: A total of 12 prospective randomized controlled trials including 42,725 patients were analyzed. Outcomes were categorized as short-term(<8 weeks) and Long-term (>8 weeks). End points included all-cause mortality, cardiovascular mortality, reinfarction rates, and left ventricular failure (LVF) for both short and long term outcome analysis. Beta blockers evaluated were acebutolol, timolol, metoprolol, propranolol, sotalol, oxprenolol and practolol. Combined odds ratios (OR) across all the studies and 95% confidence intervals (CI) were computed. A two-sided alpha error <0.05 was considered to be statistically significant.
Results: Compared to placebo group beta blocker therapy failed to show significant reduction in all cause mortality in both short term [OR: 0.93, CI: 0.85-1.01; p=0.07] and long term [OR: 1.08, 0.99-1.17; p=0.06]. However, there was significant reduction in cardiovascular mortality [Short term: OR: 0.76, CI: 0.60-0.96; p=0.02 & Long term: OR: 1.31, CI: 1.03-1.66; p=0.02], and reinfarction rates [Short term: OR: 0.70, CI: 0.56-0.87; p=0.001; & Long term: OR: 1.32, CI: 1.06-1.64; p=0.011] without increase in incidence of LVF [OR: 1.04, CI: 0.41-2.67; p=0.93].
Conclusion: Beta blocker therapy in both short- and long-term does not reduce all cause mortality but significantly reduces cardiovascular mortality and re-infarction rates in ACS patients without HF.
- © 2011 by American Heart Association, Inc.