beta Blockade after myocardial infarction: systematic review and meta regression analysis
Open accessAbstract
OBJECTIVES: To assess the effectiveness of beta blockers in short term treatment for acute myocardial infarction and in longer term secondary prevention; to examine predictive factors that may influence outcome and therefore choice of drug; and to examine the clinical importance of the results in the light of current treatment. DESIGN: Systematic review of randomised controlled trials. SETTING: Randomised controlled trials. SUBJECTS: Patients with acute or past myocardial infarction. INTERVENTION: beta Blockers compared with control. MAIN OUTCOME MEASURES: All cause mortality and non-fatal reinfarction. RESULTS: Overall, 5477 of 54 234 patients (10.1%) randomised to beta blockers or control died. We identified a 23% reduction in the odds of death in long term trials (95% confidence interval 15% to 31%), but only a 4% reduction in the odds of death in short term trials (-8% to 15%). Meta regression in long term trials did not identify a significant reduction in effectiveness in drugs with cardioselectivity but did identify a near significant trend towards decreased benefit in drugs with intrinsic sympathomimetic activity. Most evidence is available for propranolol, timolol, and metoprolol. In long term trials, the number needed to treat for 2 years to avoid a death is 42, which compares favourably with other treatments for patients with acute or past myocardial infarction. CONCLUSIONS: beta Blockers are effective in long term secondary prevention after myocardial infarction, but they are underused in such cases and lead to avoidable mortality and morbidity.
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In post-myocardial infarction and heart failure patients, beta-blockade in carefully titrated doses is associated with improved outcomes.
“In those post-myocardial infarction and in heart failure patients, use of beta-blockade in carefully titrated doses is associated with improved outcomes.62,63”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [62]
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- Authors
- Freemantle, N., Cleland, J., Young, P., Mason, J., & Harrison, J.
- Affiliations
- University of York (GB)
- University of Hull (GB)
- Corresponding author
- Freemantle, N.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1999-06-26
- Volume
- 318
- Issue
- 7200
- Pages
- 1730-1737
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC31101
- OpenAlex
- W2070568974
- Cited by
- 1,509
- References
- 34
- Citations by year
- 2026: 27 · 2025: 43 · 2024: 38 · 2023: 30 · 2022: 42 · 2021: 36 · 2020: 49 · 2019: 47 · 2018: 53 · 2017: 57 · 2016: 58 · 2015: 48 · 2014: 67 · 2013: 74 · 2012: 83
- FWCI
- 7.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Pathology and Forensic Medicine › Cardiac Ischemia and Reperfusion
- Keywords
- beta-blockers, myocardial infarction, secondary prevention, all-cause mortality, reinfarction, cardioselectivity, intrinsic sympathomimetic activity, propranolol, timolol, metoprolol, number needed to treat, predictors of treatment response
- MeSH terms
- Adrenergic beta-Antagonists, Humans, Myocardial Infarction, Regression Analysis, Randomized Controlled Trials as Topic, Treatment Outcome
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