Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial

Dargie, H. J.

doi:10.1016/s0140-6736(00)04560-8

Cited by 1,463 publications

(169 citation statements)

References 16 publications

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“…However, in the reperfusion era, few randomized, controlled trials have considered this issue. In the CAPRICORN (Carvedilol Post‐Infarct Survival Control in LV Dysfunction) trial in 2001, 1959 patients with MI who had LV dysfunction were treated with a titrated dose of carvedilol 5. Almost half of the enrolled patients underwent thrombolysis or primary angioplasty.…”

Section: Discussionmentioning

confidence: 99%

“…In the COMMIT trial,4 a fixed full dose of metoprolol was administered to all patients (15 mg intravenously, and subsequently 200 mg per day orally). In contrast, in the CAPRICORN trial,5 the dose of carvedilol was carefully titrated to maximal tolerable dose over 4 to 6 weeks (from 6.25 mg twice‐daily, and progressively up to a maximum 25 mg twice‐daily). We believe that these differences in dosage and titration strategy may plausibly explain the worse outcomes with β‐blocker therapy in the COMMIT trial, and better outcomes in the CAPRICORN trial.…”

Section: Discussionmentioning

confidence: 99%

“…However, this recommendation is based on outdated studies in the prereperfusion era. In the reperfusion era, there are only limited and controversial data for β‐blockers 4, 5. For this reason, the current European Society of Cardiology guideline no longer recommends β‐blockers for all STEMI patients without contraindications as a Class I recommendation, but instead as a Class IIa recommendation 6.…”

Section: Introductionmentioning

confidence: 99%

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Benefit of Vasodilating β‐Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study

Chung

Han

Kim

et al. 2017

JAHA

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BackgroundAlthough current guidelines recommend β‐blocker after acute myocardial infarction (MI), the role of β‐blocker has not been well investigated in the modern reperfusion era. In particular, the benefit of vasodilating β‐blocker over conventional β‐blocker is still unexplored.Methods and ResultsUsing nation‐wide multicenter Korean Acute Myocardial Infarction Registry data, we analyzed clinical outcomes of 7127 patients with acute MI who underwent successful percutaneous coronary intervention with stents and took β‐blockers: vasodilating β‐blocker (n=3482), and conventional β‐blocker (n=3645). In the whole population, incidence of cardiac death at 1 year was significantly lower in the vasodilating β‐blocker group (vasodilating β‐blockers versus conventional β‐blockers, 1.0% versus 1.9%; P=0.003). In 2882 pairs of propensity score–matched population, the incidence of cardiac death was significantly lower in the vasodilating β‐blocker group (1.1% versus 1.8%; P=0.028). Although incidences of MI (1.1% versus 1.5%; P=0.277), any revascularization (2.8% versus 3.0%; P=0.791), and hospitalization for heart failure (1.4% versus 1.9%; P=0.210) were not different between the 2 groups, incidences of cardiac death or MI (2.0% versus 3.1%; P=0.010), cardiac death, MI, or hospitalization for heart failure (3.0% versus 4.5%; P=0.003), cardiac death, MI, or any revascularization (3.9% versus 5.3%; P=0.026), and cardiac death, MI, any revascularization, or hospitalization for heart failure (4.8% versus 6.5%; P=0.011) were significantly lower in the vasodilating β‐blocker group.ConclusionsVasodilating β‐blocker therapy resulted in better clinical outcomes than conventional β‐blocker therapy did in patients with acute MI in the modern reperfusion era. Vasodilating β‐blockers could be recommended preferentially to conventional ones for acute MI patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Benefit of Vasodilating β‐Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study

Chung

Han

Kim

et al. 2017

JAHA

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“…Therefore, novel, specific assay for proBNP 1–108 may establish additional predictive ability for progressive HF events. The incidence of cardiac events was substantially lower than that reported in western countries 36, 41. Racial or ethnic differences between Japanese and western populations may mediate a difference in the response to HF therapy.…”

Section: Discussionmentioning

confidence: 66%

Association between matrix metalloproteinase‐9 and worsening heart failure events in patients with chronic heart failure

et al. 2017

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AimsMatrix metalloproteinase (MMP) is up‐regulated during heart failure (HF) and influences ventricular remodeling. We hypothesized that disparity between MMP‐9 and tissue inhibitors of MMP‐1 (TIMP‐1) results in clinical manifestations and is related to prognostic risk in patients with chronic HF.Methods and resultsPlasma levels of MMP‐9, TIMP‐1, and brain natriuretic peptide (BNP) were measured in 173 patients with chronic HF. Combined endpoints of worsening HF events were assessed during follow‐up (median 109 months). MMP‐9 and TIMP‐1 levels and the MMP‐9/TIMP‐1 ratio increased with increasing severity of the New York Heart Association class (P for trend = 0.003, 0.011, and 0.005, respectively). Patients with HF events (n = 35) had significantly higher MMP‐9 than those without HF events (P = 0.004). Kaplan–Meier analysis demonstrated a higher probability of HF events with high MMP‐9 values (>23.2 ng/mL; P = 0.005). A multivariate Cox proportional hazard model showed that high MMP‐9 values were an independent predictor of HF events (hazard ratio, 3.73; 95% confidence interval (CI), 1.03–13.46; P = 0.043). In patients with lower BNP levels (≤210 pg/mL), the adjusted hazard ratio for HF events was 3.63 (95% CI, 1.20–11.02; P = 0.023) among patients with high MMP‐9 values compared with patients with low BNP and low MMP‐9 values.ConclusionsMMP‐9 and TIMP‐1 levels correlate with the severity of chronic HF. MMP‐9 is a strong predictor of HF events, suggesting that a disparity between MMP‐9 and TIMP‐1 levels and increased MMP‐9 levels may help predict HF events.

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“…Optimal medical therapy with antiplatelet drugs, statins, and other guideline‐recommended therapies3, 4, 5, 6, 7, 8, 9, 10 are of paramount importance in preventing recurrent cardiovascular events in patients after an ACS 11. In addition, other strategies for risk‐factor modification and lifestyle changes such as diet, cardiac rehabilitation, exercise, and smoking cessation reduce the rate of recurrent cardiovascular events 12, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

Guideline‐Recommended Therapies and Clinical Outcomes According to the Risk for Recurrent Cardiovascular Events After an Acute Coronary Syndrome

Hammer

Iakobishvili

Hasdai

et al. 2018

JAHA

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BackgroundPatients who have had an acute coronary syndrome (ACS) are at increased risk of recurrent cardiovascular events; however, paradoxically, high‐risk patients who may derive the greatest benefit from guideline‐recommended therapies are often undertreated. The aim of our study was to examine the management, clinical outcomes, and temporal trends of patients after ACS stratified by the Thrombolysis in Myocardial Infarction (TIMI) risk score for secondary prevention, a recently validated clinical tool that incorporates 9 clinical risk factors.Methods and ResultsIncluded were patients with ACS enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2008 and 2016. Patients were stratified by the TIMI risk score for secondary prevention to low (score 0–1), intermediate (2), or high (≥3) risk. Clinical outcomes included 30‐day major adverse cardiac events (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1‐year mortality. Of 6827 ACS patients enrolled, 35% were low risk, 27% were intermediate risk, and 38% were high risk. Compared with the other risk groups, high‐risk patients were older, were more commonly female, and had more renal dysfunction and heart failure (P<0.001 for each). High‐risk patients were treated less commonly with guideline‐recommended therapies during hospitalization (percutaneous coronary intervention) and at discharge (statins, dual‐antiplatelet therapy, cardiac rehabilitation). Overall, high‐risk patients had higher rates of 30‐day major adverse cardiac events (7.2% low, 8.2% intermediate, and 15.1% high risk; P<0.001) and 1‐year mortality (1.9%, 4.6%, and 15.8%, respectively; P<0.001). Over the past decade, utilization of guideline‐recommended therapies has increased among all risk groups; however, the rate of 30‐day major adverse cardiac events has significantly decreased among patients at high risk but not among patients at low and intermediate risk. Similarly, the 1‐year mortality rate has decreased numerically only among high‐risk patients.ConclusionsDespite an improvement in the management of high‐risk ACS patients, they are still undertreated with guideline‐recommended therapies. Nevertheless, the outcome of high‐risk patients after ACS has significantly improved in the past decade, thus they should not be denied these therapies.

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Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial

Cited by 1,463 publications

References 16 publications

Benefit of Vasodilating β‐Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study

Benefit of Vasodilating β‐Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study

Association between matrix metalloproteinase‐9 and worsening heart failure events in patients with chronic heart failure

Guideline‐Recommended Therapies and Clinical Outcomes According to the Risk for Recurrent Cardiovascular Events After an Acute Coronary Syndrome

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