Cited by 1,509Acute Myocardial Infarction ResearchCardiac Health and Mental HealthCardiac Ischemia and Reperfusion

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beta Blockade after myocardial infarction: systematic review and meta regression analysis

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Freemantle, N., Cleland, J., Young, P., Mason, J., Harrison, J.·1999·BMJ

DOI 10.1136/bmj.318.7200.1730PMC PMC31101

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Abstract

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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Authors: Freemantle, N., Cleland, J., Young, P., Mason, J., & Harrison, J.
Affiliations: University of York (GB)
University of Hull (GB)
Corresponding author: Freemantle, N.
ORCID: Freemantle, N.
Cleland, J.
Mason, J.
Venue: BMJ
Publisher: BMJ
Published: 1999-06-26
Volume: 318
Issue: 7200
Pages: 1730-1737
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.318.7200.1730
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 › Cardiology and Cardiovascular 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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beta Blockade after myocardial infarction: systematic review and meta regression analysis

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