Beta-blockers, angiotensin-converting enzyme inhibitors, and calcium antagonists in treatment of elderly patients with acute myocardial infarction

Coronary Artery Disease

Volumn 11, Issue 4, 2000, Pages 331-338

  Aronow, Wilbert S ^a,b  

^a HEBREW HOSPITAL HOME   (United States)

^b MOUNT SINAI SCHOOL OF MEDICINE   (United States)

Author keywords

blockers; Acute myocardial infarction; Angiotensin converting enzyme inhibitors; Calcium antagonists

Indexed keywords

AMLODIPINE; ATENOLOL; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM ANTAGONIST; CAPTOPRIL; DILTIAZEM; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; ENALAPRIL; ENALAPRILAT; FELODIPINE; LISINOPRIL; METOPROLOL; NIFEDIPINE; NITRATE; PROPRANOLOL; RAMIPRIL; TIMOLOL; TRANDOLAPRIL; VERAPAMIL; ZOFENOPRIL;

ACUTE HEART INFARCTION; ANGINA PECTORIS; ARTERY DISEASE; ASTHMA; ATRIOVENTRICULAR BLOCK; BRADYCARDIA; BRONCHOSPASM; CONGESTIVE HEART FAILURE; CONVALESCENCE; DRUG CONTRAINDICATION; ELECTROCARDIOGRAM; GANGRENE; GERIATRIC PATIENT; HEART LEFT VENTRICLE EJECTION FRACTION; HUMAN; HYPOTENSION; PRACTICE GUIDELINE; PRIORITY JOURNAL; REVIEW; ST SEGMENT ELEVATION;

ADRENERGIC BETA-ANTAGONISTS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; CALCIUM CHANNEL BLOCKERS; HUMANS; METOPROLOL; MYOCARDIAL INFARCTION; PRACTICE GUIDELINES; PROPRANOLOL; TREATMENT OUTCOME;

EID: 0034047381     PISSN: 09546928     EISSN: None     Source Type: Journal    
DOI: 10.1097/00019501-200006000-00006     Document Type: Review

References (40)

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2. 2 MIAMI Trial Research Group. Metoprolol in acute myocardial infarction (MIAMI): a randomised placebo-controlled international trial. Eur Heart J 1985; 6:199-226. In the Metoprolol in Acute Myocardial Infarction Trial, metoprolol was administered intravenously within 24 h of acute myocardial infarction and then oral metoprolol therapy was implemented for 15 days. At 15-day follow-up, metoprolol had caused a 3% (NS) decrease in mortality among patients aged 60 years or less and an 18% (NS) reduction in mortality among patients aged 61-74 years compared with placebo.
3. 3 ISIS-1 (First International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous atenolol among 16,027 cases of suspected acute myocardial infarction. Lancet 1986; ii:57-66. In the First International Study of Infarct Survival, atenolol was administered intravenously within 12 h of the onset of acute myocardial infarction and then oral atenotol therapy was implemented for 7 days. At 7-day follow-up, atenolol had caused a 4% (NS) decrease in mortality among patients aged less than 65 years and a 23% (significant) reduction in mortality among patients aged 65 years and more compared with placebo.
4. 4 Roberts R, Rogers WJ, Mueller HS, Lambrew CT, Diver DJ, Smith HC, et al. Immediate versus deferred β-blockade following thrombolytic therapy in patients with acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) II-B Study. Circulation 1991; 83:422-437. In the Thrombolysis in Myocardial Infarction (TIMI) II-B Study, patients were randomly allocated intravenous metoprolol therapy within 2 hours of thrombolytic therapy and then oral metoprolol therapy immediately or starting on day six after acute myocardial infarction. There was no difference between in-hospital mortalities and 6-week mortalities for the two treatment groups. However, there was 47% (significant) less recurrence of myocardial infarction and 22% (significant) less recurrence of chest pain after 6 days for patients in the group immediately administered metoprolol intravenously.
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7. 7 Hansteen V. Beta blockade after myocardial infarction: The Norwegian Propranolol Study in high-risk patients. Circulation 1983; 67 (suppl 1):157-160. Authors of a randomized, double-blind, placebo-controlled study of propranolol therapy for high-risk survivors of acute myocardial infarction in 12 Norwegian hospitals demonstrated that there was a 52% decrease in incidence of sudden cardiac death for persons treated for 1 year with propranolol.
8. 8 Gundersen T, Abrahamsen AM, Kjekshus J, Ronnevik PK, for the Norwegian Multicentre Study Group. Timolol-related reduction in mortality and reinfarction in patients ages 65-75 years surviving acute myocardial infarction. Circulation 1982; 66:1179-1184. The Norwegian Multicentre Study of use of timolol after myocardial infarction was a placebo-controlled, double-blind study of the effect on mortality of administration of 10 mg timolol twice daily beginning 7-28 days after the onset of myocardial infarction. Patients were followed up for at least 17 months (up to 33 months). Among patients aged 65-74 years there was a 43% (significant) decrease in mortality. Among patients aged less than 65 years there was a 31% (significant) decrease in mortality.
9. 9 Pedersen TR for the Norwegian Multicentre Study Group. Six-year follow-up of the Norwegian Multicentre Study on timolol after acute myocardial infarction. N Engl J Med 1985; 313:1055-1058. In the Norwegian Multicentre Study on use of timolol after myocardial infarction, after the double-blind study had been completed, most of the patients who had been being treated with timolol continued to be administered timolol, whereas most of the patients who had been being administered placebo continued without β-blocker therapy. Duration of follow-up was at least 61 months (up to 72 months). Among patients aged 65-74 years treated with timolol there was a 19% (significant) decrease in mortality. Among patients aged less than 65 years there was a 13% (NS) reduction in mortality.
10. 10 Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. JAMA 1982; 247:1707-1714. The Beta-Blocker Heart Attack Trial was a placebo-controlled, double-blind, randomized study of the effect on mortality of administration of 60-80 mg propranolol three times daily beginning 5-21 days after the onset of myocardial infarction. Patients were followed up for at least 25 months (up to 36 months). Among patients aged 60-69 years treated with propranolol there was a 33% (significant) reduction in mortality. Among patients aged less than 60 years treated with propranotol there was a 19% (NS) decrease in mortality.
11. 11 Park KG, Forman DE, Wei JY. Utility of beta-blockade treatment for older postinfarction patients. J Am Geriatr Soc 1995; 43:751-755. Authors of a retrospective cohort study performed in the Beth Israel Hospital, Boston, USA demonstrated that there was an age-adjusted decrease in mortality of 76% among patients aged 60-89 years treated with metoprolol after myocardial infarction compared with a control group of patients not administered β-blockers.
12. 12 Chadda K, Goldstein S, Byington R, Curb JD. Effect of propranolol after acute myocardial infarction in patients with congestive heart failure. Circulation 1986; 73:503-510. In the Beta-Blocker Heart Attack Trial, use of propranolol was found to be associated with reductions in mortality of 27% among patients with histories of heart failure and 25% among patients without histories of heart failure. Use of propranolol was associated with reductions in incidence of sudden cardiac death of 47% among patients with histories of heart failure and 13% among patients without histories of heart failure.
13. 13 The Beta-Blocker Pooling Project Research Group. The Beta-Blocker Pooling Project (BBPP): subgroup findings from randomised trials in post-infarction patients. Eur Heart J 1988; 9:8-16. In the Beta-Blocker Pooling Project, the results of nine studies were pooled. These studies concerned in total 3519 patients with heart failure at the time of acute myocardial infarction before random allocation of β-blocker therapy or placebo. Use of β-blockers caused a 25% (significant) reduction in mortality compared with placebo.
14. 14 Lichstein E, Hager WD, Gregory JJ, Fleiss JL, Rolnitzky LM, Bigger JT Jr, for the Multicenter Diltiazem Post-Infarction Research Group. Relation between beta-adrenergic blocker use, various correlates of left ventricular function and the chance of developing congestive heart failure. J Am Coll Cardiol 1990; 16:1327-1332. In the Multicenter Diltiazem Post-Infarction Trial, the 2.5-year risk of mortality for persons with LVEF < 30% was 24% for patients treated with β-blockers versus 45% for patients not administered β-blockers. Use of β-blockers significantly reduced mortality (by 47%).
15. 15 Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996; 334:1349-1355. Among patients with heart failure due to coronary artery disease and a LVEF ≤ 35% treated with diuretics, ACE inhibitors, and digoxin, 6-12 months of treatment with carvedilol caused a 65% (significant) reduction in mortality compared with placebo.
16. 16 Aronow WS, Ahn C, Kronzon I. Effect of propranolol versus no propranolol on total mortality plus nonfatal myocardial infarction in older patients with prior myocardial infarction, congestive heart failure, and left ventricular ejection fraction ≥ 40% treated with diuretics plus angiotensin-converting-enzyme inhibitors. Am J Cardiol 1997; 80:207-209. A prospective study was performed on 158 old persons (111 women and 47 men), mean age 81 years, with congestive heart failure, prior myocardial infarction, and a LVEF ≥ 40% treated with diuretics plus ACE inhibitors. At 32-month follow-up, there was a 35% (significant) reduction in mortality and a 37% (significant) decrease in mortality plus incidence of nonfatal myocardial infarction among persons randomly allocated propranolol therapy compared with persons not treated with propranolol. At 1-year follow-up, there was a significantly greater increase in LVEF and a significantly greater reduction in left ventricular mass for persons randomly allocated to propranolol therapy than there was for persons not treated with propranolol.
17. 17 Kennedy HL, Brooks MM, Barker AH, Bergstrand R, Huther ML, Beanlands DS, et al. Beta-blocker therapy in the Cardiac Arrhythmia Suppression Trial. Am J Cardiol 1994; 74:674-680.
18. 18 Aronow WS, Ahn C, Mercando AD, Epstein S, Kronzon I. Effect of propranolol versus no antiarrhythmic drug on sudden cardiac death, total cardiac death, and total death in patients ≥ 62 years of age with heart disease, complex ventricular arrhythmias, and left ventricular ejection fraction ≥ 40%. Am J Cardiol 1994; 74:267-270. A prospective study was performed on 245 old persons (158 women and 87 men), mean age 81 years, with heart disease (64% with prior myocardial infarction and 36% with hypertensive heart disease), complex ventricular arrhythmias, and LVEF ≥ 40%. At 30-month follow-up, there was a 47% (significant) reduction in sudden cardiac death, a 37% (significant) decrease in total cardiac death, and a 20% (borderline significance; P=0.057) reduction in total mortality among persons randomly allocated propranolol therapy.
19. 19 Aronow WS, Ahn C, Mercando AD, Epstein S, Kronzon I. Decrease of mortality by propranolol in patients with heart disease and complex ventricular arrhythmias is more an anti-ischemic than an antiarrhythmic effect. Am J Cardiol 1994; 74:613-615.
20. 20 Aronow WS, Ahn C, Mercando AD, Epstein S. Effect of propranolol on circadian variation of ventricular arrhythmias in elderly patients with heart disease and complex ventricular arrhythmias. Am J Cardiol 1995; 75:514-516.
21. 21 Aronow WS, Ahn C, Mercando AD, Epstein S. Effect of propranolol on circadian variation of myocardial ischemia in elderly patients with heart disease and complex ventricular arrhythmias. Am J Cardiol 1995; 75:837-839.
22. 22 Aronow WS, Ahn C, Mercando AD, Epstein S. Circadian variation of sudden cardiac death or fatal myocardial infarction is abolished by propranolol in patients with heart disease and complex ventricular arrhythmias. Am J Cardiol 1994; 74:819-821.
23. 23 Soumerai SB, McLaughlin TJ, Spiegelman D, Hertzmark E, Thibault G, Goldman L. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA 1997; 277:115-121. A retrospective analysis of the use of β-blockers after myocardial infarction in treating a New Jersey Medicare population from 1987 to 1992 revealed that only 21% of persons aged ≥ 65 years without contraindications to use of β-blockers had been treated with β-blockers. Among old persons who had been treated with β-blockers after myocardial infarction there was a 43% (significant) lower 2-year mortality and a 22% (significant) lower incidence of readmission to cardiac hospital within 2 years than there was for old persons not administered β-blockers. Use of a calcium antagonist instead of a β-blocker after myocardial infarction doubled the risk of mortality. Use of β-blockers significantly decreased mortality after myocardial infarction among persons aged 65-74, 75-84, and ≥ 85 years.
24. 24 Yusuf S, Wittes J, Probstfield J. Evaluating effects of treatment subgroups of patients within a clinical trial: The case of non-Q-wave myocardial infarction and beta blockers. Am J Cardiol 1990; 60:220-222. A meta-analysis of trials showed that the use of β-blockers after non-Q-wave myocardial infarction was likely to decrease mortality and recurrence of myocardial infarction by 25%.
25. 25 Ryan TJ, Anderson JL, Antman EM, Braniff BA, Brooks NH, Califf RM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 1996; 94:2341-2350. The American College of Cardiology/American Heart Association guidelines recommend that persons without contraindications to β-blocker therapy should be administered β-blockers within a few days of myocardial infarction (if administration is not initiated acutely) and that their administration should continue indefinitely. Use of ACE inhibitors is recommended for patients within the first 24 h of suspected acute myocardial infarction with ST-segment elevation in two or more anterior precordial leads or with heart failure in the absence of significant hypotension or other contraindications to use of ACE inhibitors; and during and after convalescence from acute myocardial infarction with heart failure associated with an abnormal LVEF or with asymptomatic left ventricular systolic dysfunction with an ejection fraction < 40%. There are no class I indications for use of calcium antagonists during and after acute myocardial infarction.
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30. 30 Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ Jr, Cuddy TE, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement Trial. N Engl J Med 1992; 327:669-677. In the Survival and Ventricular Enlargement (SAVE) Trial, asymptomatic persons with LVEF≤ 40% were treated with captopril or placebo 3-16 days after acute myocardial infarction. At 42-month follow-up, administration of captopril had caused an 8% (NS) decrease in mortality among 740 persons aged ≤ 55 years, a 13% (NS) reduction in mortality among 708 persons aged 55-64 years, and a 25% (significant) decrease in mortality among 783 persons aged ≥ 65 years compared with placebo. Administration of captopril caused a 19% (significant) reduction in total mortality, a 21% (significant) decrease in cardiovascular mortality, a 37% (significant) reduction in the incidence of development of severe heart failure, a 22% (significant) decrease in the incidence of development of heart failure requiring hospitalization, and a 25% (significant) reduction in recurrence of myocardial infarction compared with placebo.
31. 31 The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342:821 -828. In the Acute Infarction Ramipril Efficacy (AIRE) Study, 2006 persons with clinical evidence of heart failure were randomly allocated ramipril therapy or placebo 3-10 days after acute myocardial infarction. At 1 5-month follow-up, administration of ramipril had reduced mortality by 2% (NS) among persons aged < 65 years and by 36% (significant) among persons aged ≥ 65 years compared with placebo.
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37. 37 The Multicenter Diltiazem Postinfarction Trial Research Group. The effect of diltiazem on mortality and reinfarction after myocardial infarction. N Engl J Med 1988; 319:385-392. Authors of The Multicenter Diltiazem Postinfarction Trial showed that, at 25-month follow-up of patients after myocardial infarction, administration of diltiazem had exerted no significant effect on mortality or recurrence of myocardial infarction compared with placebo. However, among patients with pulmonary congestion at baseline or LVEF < 40%, use of diltiazem caused a significant increase in incidence of new cardiac events (hazard ratios 1.41 and 1.31, respectively).
38. 38 Goldstein RE, Boccuzzi SJ, Cruess D, Nattel S. Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. Circulation 1991; 83:52-60.
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40. 40 Danish Study Group on Verapamil in Myocardial Infarction. Trial II-DAVIT II. Effect of verapamil on mortality and major events after acute myocardial infarction. Am J Cardiol 1990; 66:779-785.