Retrospective Analysis Showing Less Cardiac Events in Post-Myocardial Infarction Patients Treated With Metoprolol

Ishikawa, Kinji; Miyataka, Masaru; Kanamasa, Ken; Hayashi, Tetsuo; Takenaka, Toshihiko; Inoki, Tatsu; Katayama, Katsuhiko; Kimura, Akio; Yabushita, Hiroshi; Kitayama, Kouji

doi:10.1253/jcj.64.358

Cited by 10 publications

(9 citation statements)

References 28 publications

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“…Nevertheless, in the present study we found that -blockers improved patient outcomes to a degree similar to that seen in Western populations. In our previous reports, 7,8 we concluded that -blockers effectively prevented cardiac events in patients with MI on the basis of data from 1,485 patients treated between 1986 and 1999. By increasing the number of cases to 1,896 and lengthening the study period up to 2002, we have been able to confirm the validity of the results of those earlier studies.…”

Section: Discussionmentioning

confidence: 89%

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Beta-Blockers Prevent Cardiac Events in Japanese Patients With Myocardial Infarction

Ishikawa

Miyataka

Kimura

et al. 2004

Circ J

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n Western countries, -blockers have been frequently proved to be effective in the treatment of myocardial infarction (MI); for example, the BHAT ( -Blocker Heart Attack Trial) in 1982. 1 In that trial, 3,837 patients with MI were randomized into 2 groups, a propranolol group, consisting of 1,916 patients, and a placebo group of 1,921 patients and they were followed up for mean period of 25 months. The total mortality rate was 9.8% in the placebo group and 7.2% in the propranolol group, indicating that propranolol had an effect on improving the long-term prognosis following MI. Many similar clinical trials were also carried out at that time, and an overview by Yusuf et al concluded that -blockers reduced total mortality by 25% and they should be provided to the patient at discharge. 2 According to these findings, -blocker usage has substantially increased in Western countries. In Israel, for instance, the frequency of prescribed -blockers has increased from 17% (at 1981-1983) to 38% (at 1992-1994) and it is believed that the increased frequency has made an obvious contribution to the reduced mortality rates because of MI. 3 In Minneapolis and St Paul, Minnesota, USA, surveys of coronary heart disease were carried out at 5-year intervals, and changes in the treatment planning and their effects on the prognosis of MI were analyzed. According to these studies, the 3-year mortality rate among males admitted Circulation Journal Vol.68, January 2004with acute MI was 28% in 1985, which decreased to 19% in 1995, with the concomitant increased frequency ofblocker administration from 54% to 72% and aspirin from 26% to 92%. 4 Among European patients with MI, the use of -blockers has exceeded 80% in Sweden and Finland since 1993. 5 On the basis of that abundant clinical experience, the guidelines for the treatment of acute MI at the European Secondary Prevention Study Group 5 and the ACC/AHA (American College of Cardiology/American Heart Association) Task Force on Practice Guidelines 6 recommended prescribing -blockers for patients discharged after MI for the purpose of secondary prevention of this disease.In contrast, clinical data on the use of -blockers for MI in Japan are rather limited, and available reports are also limited. 7-9 Consequently, -blocker usage for patients with MI is markedly lower in Japan than in Western countries. Ischemic heart disease certainly differs between Japanese and Caucasians in some aspects; for example, coronary vasospasm occurs 3 times more frequently in Japan than in Western countries. 10 Therefore, the useful effects of this drug should be evaluated on the basis of original evidence obtained in Japan. In this retrospective study, we evaluated the effect of -blockers on the clinical courses of MI patients treated at our hospital with and without -blockers. Methods SubjectsPatients who underwent outpatient or inpatient management for MI at the Department of Cardiology, Kinki University Hospital were retrospectively divided into 2 groups, those treated with -blockers and those treated wit...

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Section: Discussionmentioning

confidence: 89%

“…[7][8][9] Consequently, -blocker usage for patients with MI is markedly lower in Japan than in Western countries. Ischemic heart disease certainly differs between Japanese and Caucasians in some aspects; for example, coronary vasospasm occurs 3 times more frequently in Japan than in Western countries.…”

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confidence: 99%

Beta-Blockers Prevent Cardiac Events in Japanese Patients With Myocardial Infarction

Ishikawa

Miyataka

Kimura

et al. 2004

Circ J

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“…The study population, design and method have been reported elsewhere. 11,12) Patient enrollment, study period, and exclusion criteria: Enrollment of this study population was initiated in 1986 and terminated in 1999. Pravastatin became available in 1990 in Japan.…”

Section: Methodsmentioning

confidence: 99%

Pravastatin Reduces the Incidence of Cardiac Events Among Patients With Myocardial Infarction.

et al. 2003

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SUMMARYWe retrospectively compared the incidence of cardiac events in myocardial infarction (MI) patients treated in our departments between 1990 and 1999 with pravastatin or without cholesterol-lowering agents. Our aim was to evaluate the efficacy of pravastatin in the secondary prevention of MI. Cardiac events -defined as fatal or nonfatal recurrent MI, sudden cardiac death, and death from congestive heart failure -occurred in 8 (2.2%) of 356 MI patients treated with pravastatin (17.1 cases/1,000 person • year) and in 39 (5.6%) of 700 MI patients not treated with cholesterol-lowering agents (54.3 cases/1,000 person • year), which represented a significant decline among those taking pravastatin (P < 0.05, odds ratio : 0.39, 95% CI: 0.18-0.84). Likewise, total mortality was significantly lower among patients treated with pravastatin (18 cases, 5.1% ; 38.4 cases/1,000 person • year vs 77 cases, 11.0% ; 107.2 cases/1,000 person • year, P < 0.01, odds ratio : 0.43, 95% CI: 0.25-0.73). Subgroup analysis revealed a significantly lower incidence of cardiac events in the pravastatin group for 6 of the items among 53 patient characteristics, and was lower but not significant for 45 items and was greater but not significant only for 2 items. Furthermore, multivariate analysis confirmed pravastatin to be a useful factor for preventing the occurrence of cardiac events in MI patients (P < 0.05, odds ratio: 0.44, 95% CI: 0.20-0.95), and Kaplan-Meier curves also showed pravastatin to significantly reduce the incidence of both cardiac events and total mortality. These findings are consistent with those previously reported by several large-scale clinical trials carried out in Western countries, and demonstrate that pravastatin is useful for secondary prevention of MI in Japanese patients. (Jpn Heart J 2003; 44: 873-887)

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“…9 Consistent with those findings, we also found that increased use of ACEI likely contributes to improved long-term prognosis. The important role ofblockers for secondary prevention of MI has been pointed out repeatedly, 15,16 but their use is limited, especially among elderly patients. 17 Use of -blockers in our study population was high compared with that described by Heller et al, who reported that the use of -blockers among elderly survivors of acute MI (>65 years of age) increased from 39.6% in 1994 to 58.6% in 1997.…”

Section: Effective Secondary Prevention Of MImentioning

confidence: 99%

Modification of Treatment Strategies Over a Period of 14 Years Has Markedly Reduced Cardiac Events Among Post-Myocardial Infarction Patients.

Ishikawa

Kimura

Taniwa

et al. 2002

Circ J

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Retrospective Analysis Showing Less Cardiac Events in Post-Myocardial Infarction Patients Treated With Metoprolol

Cited by 10 publications

References 28 publications

Beta-Blockers Prevent Cardiac Events in Japanese Patients With Myocardial Infarction

Beta-Blockers Prevent Cardiac Events in Japanese Patients With Myocardial Infarction

Pravastatin Reduces the Incidence of Cardiac Events Among Patients With Myocardial Infarction.

Modification of Treatment Strategies Over a Period of 14 Years Has Markedly Reduced Cardiac Events Among Post-Myocardial Infarction Patients.

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