Background Long-term administration of beta-adrenergic blockersto patients after myocardial infarction improves survival. However,physicians are reluctant to administer beta-blockers to manypatients, such as older patients and those with chronic pulmonarydisease, left ventricular dysfunction, or non–Q-wave myocardialinfarction.
Methods The medical records of 201,752 patients with myocardialinfarction were abstracted by the Cooperative CardiovascularProject, which was sponsored by the Health Care Financing Administration.Using a Cox proportional-hazards model that accounted for multiplefactors that might influence survival, we compared mortalityamong patients treated with beta-blockers with mortality amonguntreated patients during the two years after myocardial infarction.
Results A total of 34 percent of the patients received beta-blockers.The percentage was lower among the very elderly, blacks, andpatients with the lowest ejection fractions, heart failure,chronic obstructive pulmonary disease, elevated serum creatinineconcentrations, or type 1 diabetes mellitus. Nevertheless, mortalitywas lower in every subgroup of patients treated with beta-blockadethan in untreated patients. In patients with myocardial infarctionand no other complications, treatment with beta-blockers wasassociated with a 40 percent reduction in mortality. Mortalitywas also reduced by 40 percent in patients with non–Q-waveinfarction and those with chronic obstructive pulmonary disease.Blacks, patients 80 years old or older, and those with a leftventricular ejection fraction below 20 percent, serum creatinineconcentration greater than 1.4 mg per deciliter (124 µmolper liter), or diabetes mellitus had a lower percentage reductionin mortality. Given, however, the higher mortality rates inthese subgroups, the absolute reduction in mortality was similarto or greater than that among patients with no specific riskfactors.
Conclusions After myocardial infarction, patients with conditionsthat are often considered contraindications to beta-blockade(such as heart failure, pulmonary disease, and older age) andthose with nontransmural infarction benefit from beta-blockertherapy.
Source Information
From the Department of Medicine and the Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore.
Address reprint requests to Dr. Gottlieb at the Division of Cardiology, University of Maryland Medical Systems, 22 S. Greene St., Baltimore, MD 21201.
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