Objectives To assess the effectiveness of bêta blockers in short term treatment for acute myocardial infarction and in longer term secondary prevention ; to examine predictive factors that may influence outcome and therefore choice of drug ; and to examine the clinical importance of the results in the light of current treatment Design Systematic review of randomised controlled trials.
Subjects Patients with acute or past myocardial infarction.
Main outcome measures All cause mortality and non-fatal reinfarction.
Results Overall, 5477 of 54 234 patients (10.1%) randomised to bêta blockers or control died.
We identified a 23% reduction in the odds of death in long term trials (95% confidence interval 15% to 31%), but only a 4% reduction in the odds of death in short term trials (-8% to 15%). Meta regression in long term trials did not identify a significant reduction in effectiveness in drugs with cardioselectivity but did identify a near significant trend towards decreased benefit in drugs with intrinsic sympathomimetic activity.
Most evidence is available for propranolol, timolol, and metoprolol.
In long term trials, the number needed to treat for 2 years to avoid a death is 42, which compares favourably with other treatments for patients with acute or past myocardial infarction. (...)
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Bloquant bêta-adrénergique, Essai thérapeutique contrôlé, Efficacité traitement, Long terme, Randomisation, Métaanalyse, Prévention, Secondaire, Article synthèse, Analyse statistique, Homme, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Beta blocking agent, Controlled therapeutic trial, Treatment efficiency, Long term, Randomization, Metaanalysis, Prevention, Secondary, Review, Statistical analysis, Human, Cardiovascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0362151
Code Inist : 002B02A03. Création : 14/12/1999.