Comparison of carvedilol and metoprolol in patients with acute myocardial infarction undergoing primary coronary intervention

Tölg, Ralph; Witt, Maren; Schwarz, Bettina; Kurz, Thomas; Kurowski, V.; Hartmann, Franz; Geist, Volker; Richardt, Gert

doi:10.1007/s00392-006-0317-7

Cited by 27 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…31 In addition, the PASSAT trial showed that carvedilol was not superior to metoprolol with respect to myocardial injury and improvement of global and regional LV function when administered before reperfusion in patients with ST-segment-elevation MI undergoing percutaneous coronary intervention. 32 There were no differences in any cardiac events, including cardiac death (2.0% versus 0.0%; P=0.99), reinfarction (0.0% versus 2.0%; P=0.99), or shock (2.0% versus 4.0%; P=0.99) between carvedilol versus metoprolol groups.…”

Section: Newer Vasodilating β-Blockersmentioning

confidence: 83%

β-Blockers and Cardiovascular Events in Patients With and Without Myocardial Infarction

Bangalore

Bhatt

Steg

et al. 2014

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background-The long-term efficacy of β-blockers in patients with and without myocardial infarction (MI) is controversial. Methods and Results-This is post hoc analysis from the Clopidogrel for High Atherothrombotic Risk and IschemicStabilization, Management, and Avoidance (CHARISMA) trial of 4772 patients with prior MI, 7804 patients with known atherothrombosis, and 2101 patients with risk factors alone but without heart failure. Primary outcome was a composite of nonfatal MI, stroke, or cardiovascular mortality. The cohorts were divided into 2 groups based on baseline β-blocker use.In the propensity score-matched prior MI cohort, after 28 months of follow-up, β-blocker use was associated with a 31% 20).In the known atherothrombotic disease and the risk factors alone cohorts, β-blocker use was not associated with lower ischemic outcomes, whereas a trend toward a higher risk of stroke (3.5% versus 1.5%; hazards ratio, 2.13; 95% confidence interval, 0.92-4.92; P=0.079) was observed in the risk factors alone cohort. This higher stroke risk was significant in the regression model adjusted to the propensity score (hazards ratio, 2.69; 95% confidence interval, 1.33-5.44; P=0.006) and in the multivariable models. Conclusions-β-blocker use in patients with prior MI but no heart failure was associated with a lower composite cardiovascular outcome driven by lower risk of recurrent MI with no difference in mortality. However, β-blocker use was not associated with lower cardiovascular events in those without MI, with a suggestion of inferior outcome with regard to stroke risk. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00050817.(Circ Cardiovasc Qual Outcomes. 2014;7:872-881.)

show abstract

Section: Newer Vasodilating β-Blockersmentioning

confidence: 83%

β-Blockers and Cardiovascular Events in Patients With and Without Myocardial Infarction

Bangalore

Bhatt

Steg

et al. 2014

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…In head-to-head trials, carvedilol has been at least as effective as metoprolol in terms of anti-ischemic effects. 12–13 While there is no inherent reason to believe that medications such as labetolol or nebivolol would not be effective in reducing the risk of adverse ischemic events after an MI, this lack of outcomes data may have affected the practice patterns of some physicians; nevertheless, these medications constituted only a small fraction of DM-friendly beta blockers in our study (6%). Further qualitative research would be informative to better understand why physicians choose one beta-blocker over another after an MI.…”

Section: Discussionmentioning

confidence: 88%

“…29–31 Although confirmation in a larger study is needed, our results suggest that the metabolic differences between different beta-blockers may have clinically important implications. As such, treating DM patients with DM-friendly beta-blockers post-MI seems to be the optimal strategy, particularly since there is no downside in terms of their cardioprotective effects 12–13 or associated costs (e.g., carvedilol is available as a generic medication and as a $4/month drug at many pharmacies 14–15 ).…”

Section: Discussionmentioning

confidence: 99%

“…Given the multiple beta-blockers available—with varying metabolic effects, similar cardioprotective properties 12–13 , and equal costs 14–15 —we studied whether providers apply this concept in clinical practice. In addition, we evaluated whether prescription of beta-blockers with unfavorable glycometabolic profile is associated with worse glycemic control post-discharge.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Type of β-blocker use among patients with versus without diabetes after myocardial infarction

Arnold

Spertus

Lipska

et al. 2014

American Heart Journal

View full text Add to dashboard Cite

Background Discharge beta-blocker prescription after myocardial infarction (MI) is recommended for all eligible patients. Numerous beta-blocker choices are presently available with variable glycometabolic effects, which could be an important consideration in patients with diabetes mellitus (DM). Whether patients with DM preferentially receive beta-blockers with favorable metabolic effects after MI and if this choice is associated with better glycemic control post-discharge is unknown. Methods Among patients from 24 US hospitals enrolled in an MI registry (2005–08), we investigated the frequency of “DM-friendly” beta-blocker prescription at discharge by DM status. Beta-blockers were classified as DM-friendly (e.g., carvedilol, labetalol), or non-DM-friendly (e.g., metoprolol, atenolol), based on their effects on glycemic control. Hierarchical, multivariable logistic regression examined the association of DM with DM-friendly beta-blocker use. Among DM patients, we examined the association of DM-friendly beta-blockers with worsened glycemic control at 6 months after MI. Results Of 4031 MI patients, 1382 (34%) had DM. Beta-blockers were prescribed at discharge in 93% of patients. DM-friendly beta-blocker use was low regardless of DM status, although patients with DM were more likely to be discharged on a DM-friendly beta-blocker compared with patients without DM (13.5% vs. 10.3%, p=0.003), an association that remained after multivariable adjustment (OR 1.41, 95% CI 1.13–1.77). There was a trend toward a lower risk of worsened glucose control at 6 months in DM patients prescribed DM-friendly vs. non-friendly beta-blockers (RR 0.80, 95% CI 0.60–1.08). Conclusion The vast majority of DM patients were prescribed non-DM friendly beta-blockers—a practice that was associated with a trend towards worse glycemic control post-discharge. While in need of further confirmation in larger studies, our findings highlight an opportunity to improve current practices of beta-blockers use in patients with DM.

show abstract

“…Carvedilol and metoprolol are among the most widely prescribed β-blockers in the post-AMI setting. In chronic heart failure, Carvedilol has been shown to be superior than metoprolol [2], however there is not much data on their comparison in the acute phase of AMI, even though inconclusive data suggest the superiority of carvedilol [3].…”

Section: Introductionmentioning

confidence: 99%

Carvedilol administration in acute myocardial infarction results in stronger inhibition of early markers of left ventricular remodeling than metoprolol

Cimmino

Ibáñez

Giannarelli

et al. 2011

International Journal of Cardiology

View full text Add to dashboard Cite

Comparison of carvedilol and metoprolol in patients with acute myocardial infarction undergoing primary coronary intervention

Cited by 27 publications

References 23 publications

β-Blockers and Cardiovascular Events in Patients With and Without Myocardial Infarction

β-Blockers and Cardiovascular Events in Patients With and Without Myocardial Infarction

Type of β-blocker use among patients with versus without diabetes after myocardial infarction

Carvedilol administration in acute myocardial infarction results in stronger inhibition of early markers of left ventricular remodeling than metoprolol

Contact Info

Product

Resources

About