Short-term effects of early intravenous treatment with a beta-adrenergic blocking agent or a specific bradycardiac agent in patients with acute mycardial infarction receiving thrombolytic therapy

Werf, Frans Van de; Janssens, Luc; Brzostek, Tomasz; Mortelmans, Luc; Wackers, J.T.H.; Willems, G.M.; Heidbüchel, Hein; Lesaffre, Emmanuel; Scheys, Ilse; Collen, D.; Geest, H De

doi:10.1016/0735-1097(93)90044-2

Cited by 105 publications

(43 citation statements)

References 34 publications

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“…Moreover, alinidine-treated patients tended to have smaller infarcts compared with placebo and atenolol patients. 7 The trend toward a higher incidence of AIVR in the active treatment groups can be explained by the bradycardiac effect, which increases the probability of AIVR to break through the sinus rhythm, and does not appear to be the expression of a proarrhythmic effect. The same observation was made in the TIMI 1I-B trial.6 Remarkably, the rate of the AIVR runs was not changed by /3-blocker therapy or by alinidine.…”

Section: Sustained Ventricular Tachycardia and Ventricular Fibrillationmentioning

confidence: 99%

Significance of arrhythmias during the first 24 hours of acute myocardial infarction treated with alteplase and effect of early administration of a beta-blocker or a bradycardiac agent on their incidence.

et al. 1994

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BACKGROUND Although early intravenous beta-blocker therapy during acute myocardial infarction (AMI) reduces the incidence of fatal arrhythmias in patients not treated with thrombolytic agents, its antiarrhythmic effect in thrombolysed patients remains controversial. We investigated prospectively the arrhythmia incidence in 244 patients with AMI receiving alteplase and a double-blind randomized adjunctive therapy with intravenous atenolol, alinidine, or placebo. Moreover, the characteristics and prognostic significance of early arrhythmias and their relation with infarct size and coronary patency were evaluated. METHODS AND RESULTS All patients underwent 24-hour Holter monitoring on day 1 and were clinically followed in the hospital for 10 to 14 days. Coronary angiography was performed on day 10 to 14. Atenolol and alinidine significantly decreased the basic heart rate without causing more sinus arrest or higher-degree atrioventricular block. The prevalence of atrial fibrillation in alinidine patients was lower than in the atenolol patients (P = .007) but not lower than in placebo patients (P = .11). There was no effect of either agent on the incidence and frequency distribution of ventricular or supraventricular premature beats or on the incidence and characteristics of nonsustained ventricular tachycardia, accelerated idioventricular rhythm, sustained ventricular tachycardia (VT), or ventricular fibrillation (VF). On day 1, seven VF episodes were recorded in six patients (2.5%) and five VT episodes in five patients (2%). VF always started at < 2.5 hours after start of thrombolytic treatment and VT always at > 2.5 hours (average of 6 hours). Five of the seven VF and three of the five VT episodes started with an R-on-T. However, for all VT, the morphology of the first beat was the same as that of the following beats, suggesting that the sustained arrhythmia was not induced by an extrasystole. After day 1 and before hospital discharge, VF and VT developed in one and six patients, respectively. Three of the seven patients who developed VF during the first 2 weeks underwent coronary angiography; all three had an occluded infarct-related artery. In contrast, only one of nine patients with early or late VT had an occluded vessel. Patients with VT and VF on day 1 had a significantly larger enzymatic infarct size than those without the arrhythmia (P = .02), and a similar trend was noted for VT or VF after day 1 (P = .19). However, none of the patients with VT or VF on day 1 developed a life-threatening arrhythmia later during the hospital stay. Also, none of the seven patients with VT or VF after day 1 had experienced a major rhythm disturbance during the first 24 hours. CONCLUSIONS (1) Our data do not support the hypothesis that beta-blockers or bradycardiac agents might reduce the incidence of major arrhythmias when used in conjunction with thrombolytic therapy. (2) The pathogeneses of VT and VF early during AMI are clearly distinct. (3) VT or VF during the first 2 weeks is a marker for a larger infarct. (4) We could not detect a relation between malignant arrhythmias on day 1 and recurrences within the following 2 weeks.

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Section: Sustained Ventricular Tachycardia and Ventricular Fibrillationmentioning

confidence: 99%

Significance of arrhythmias during the first 24 hours of acute myocardial infarction treated with alteplase and effect of early administration of a beta-blocker or a bradycardiac agent on their incidence.

et al. 1994

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“…No entanto, esses estudos foram conduzidos antes da era dos fibrinolíticos e da angioplastia primária, o que não representa o universo global de pacientes que são atendidos com IAM. Dois estudos randomizados 313,314 com betabloqueadores intravenosos foram avaliados após o uso rotineiro dos fibrinolíticos, porém o número de eventos foi muito pequeno para se chegar a conclusões. Já no estudo TIMI-2 (Thrombolysis in Myocardial Infarction) 315 , os pacientes submetidos a trombólise e randomizados para o uso de metoprolol intravenoso tiveram menor incidência de reinfarto e isquemia recorrente.…”

Section: -Betabloqueadoresunclassified

III Diretriz sobre tratamento do infarto agudo do miocárdio

Avezum¹,

Carvalho²,

Mansur³

et al. 2004

Arq. Bras. Cardiol.

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Classe I: evidência ou concordância geral de que o tratamento é benéfico, útil e eficaz.Classe II: evidência conflitante e/ou divergência de opinião quanto à utilidade e à eficácia do tratamento.Classe IIa: forças das evidências/opiniões em favor da utilidade e da eficácia.Classe IIb: forças das evidências/opiniões menos bem estabelecidas quanto à utilidade e à eficácia.Classe III: evidência ou concordância geral de que o tratamento não é útil/eficaz e em alguns casos pode ser prejudicial. Nível de evidência A: presença de múltiplos estudos clínicos randomizados.Nível de evidência B: presença de um único estudo clínico randomizado ou de estudos não-randomizados.Nível de evidência C: consenso de especialistas.O nível de evidência será apresentado apenas para os tratamentos do infarto do miocárdio, não se aplicando aos procedimentos diagnósticos. Todos os métodos complementares deverão ser realizados por profissionais experientes, segundo as recomendações específicas de cada especialidade.

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“…Among those treated especially early (ie, within 2 h of symptom onset), the composite endpoint of death or reinfarction occurred less often in those given immediate IV metoprolol than in those who did not receive it. The benefits of routine early IV use of β-blockers in the fibrinolytic era have been challenged by 2 later randomized trials of IV β-blockade 7, 8 and by a post hoc analysis of the use of atenolol in the GUSTO-I trial. 9 A subsequent systematic review of early β-blocker therapy for STEMI found no significant reduction in mortality.…”

Section: Article P 439mentioning

confidence: 99%

Effect and Safety of Landiolol in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Yoshiyama

2012

Circ J

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302YOSHIYAMA M it offers considerable advantages over longer acting agents when the risk of a β-blocker complication is relatively high. The authors comment that the number of study patients was small, and it may be difficult to conclude the efficacy of landiolol in patients with AMI undergoing primary PCI. We have to have confirmation that early IV administration of landiolol in patients with AMI undergoing PCI may limit the size of the infarction. Therefore, we should precisely estimate the infarct size using MRI or radio-isotope. We have to have a further study of the effectiveness of IV administration of landiolol in patients with AMI undergoing PCI.

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Short-term effects of early intravenous treatment with a beta-adrenergic blocking agent or a specific bradycardiac agent in patients with acute mycardial infarction receiving thrombolytic therapy

Cited by 105 publications

References 34 publications

Significance of arrhythmias during the first 24 hours of acute myocardial infarction treated with alteplase and effect of early administration of a beta-blocker or a bradycardiac agent on their incidence.

Significance of arrhythmias during the first 24 hours of acute myocardial infarction treated with alteplase and effect of early administration of a beta-blocker or a bradycardiac agent on their incidence.

III Diretriz sobre tratamento do infarto agudo do miocárdio

Effect and Safety of Landiolol in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

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