A Long-Term Prevention Study with Oxprenolol in Coronary Heart Disease

Abstract

We carried out a randomized double-blind controlled secondary-prevention trial of oxprenolol over seven years. Forty milligrams of oxprenolol or placebo was given twice daily to 1103 men 35 to 65 years old who had an acute myocardial infarction between 1 and 90 months previously. Overall, there was no difference in mortality or cardiac events between the placebo and oxprenolol groups. The major influence on prognosis was the time at which treatment was started after infarction. In 417 patients in whom treatment was started within four months of infarction oxprenolol increased the six-year cumulative survival rate from 77 to 95 per cent (P less than 0.001). In 274 patients with treatment starting between 5 and 12 months of infarction the survival rate was similar in the two groups, but in 412 patients entered between 1 and 7 1/2 years after their first infarction oxprenolol reduced the six-year survival rate from 92 to 79 per cent (P = 0.002). The increased mortality in this latter group mainly occurred late after withdrawal from active treatment. The value of low-dose oxprenolol in secondary prevention appears to be confined to patients treated relatively soon after myocardial infarction.

Cost-Effectiveness of Interventions to Prevent or Treat Coronary Heart Disease

“…Analogous results were fo und in randomized trials of practolol (58), timolol (62), and oxprenolol (72). In these four trials, relative reductions in mortality in the treated groups ranged from 27% to 45%.…”

“…In the past several years, four independent, randomized trials have found that beta-adrenergic blocking agents increase survival when administered soon after acute myocardial infarctions (MI) (4,58,62,72). No evidence, pro or con, has been reported to date on the ability of such drugs to reduce mortality in patients with stable angina, but the temporal trend toward increased survival among patients treated medically in trials involving bypass surgery (5,24,70) sug gests that beta blockade may be beneficial.…”

The large studies in hypertension: what have they shown?

“…A particular hope was that these agents might protect against coronary events (Robertson, 1978), a hope that was encouraged by their undoubted success when given after myocardial infarction (Robertson, 1983b; Norwegian Multicenter Study Group, 1981; Beta-Blocker Heart Attack Study Group, 1981;Hjalmarson et al, 1981;Editorial, 1982;Hampton, 1981). It was in this connection disconcerting to read in the introduction to the report (The IPPPSH Collaborative Group, 1985) that a major reason for selecting oxprenolol for evaluation was an earlier successful postinfarction study (Taylor et al, 1982) using that drug. The outcome of that earlier trial was a good deal less clear than the authors of IPPPSH imply; there was no overall difference in either mortality or cardiac events between the placebo and oxprenolol groups.…”

Comparative haemodynamic effects of intravenous lignocaine, disopyramide and flecainide in uncomplicated acute myocardial infarction

“…Patients with 'definite' infarction assessed by Minnesota Code electrocardiographic criteria (Rose & Blackburn, 1968;Taylor et al, 1982), on admission to the Coronary Care Unit, were routinely monitored with a Swan-Ganz thermodilution catheter to detect clinically unrecognised heart failure. Patients found to be haemodynamically uncomplicated were requested to participate in this study and following informed consent allocated to receive 120 min infusion of lignocaine (Group I), disopyramide (Group II) or flecainide (Group III).…”