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Intravenous beta-blockers in ST-segment elevation myocardial infarction: A systematic review and meta-analysis

Lee H Sterling, Kristian B Filion, Renee Atallah, Pauline Reynier, Mark J Eisenberg
International Journal of Cardiology 2017 February 1, 228: 295-302
27866018

BACKGROUND/OBJECTIVES: The role of intravenous (IV) beta-blockers in conjunction with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains unclear. We therefore conducted a meta-analysis to assess their role in the acute phase of STEMI.

METHODS: We systematically searched the Cochrane Libraries, Medline, and EMBASE for RCTs comparing IV beta-blockers with inactive controls in STEMI patients undergoing PCI. The primary outcome was left ventricular ejection fraction (LVEF). Pooling was performed using DerSimonian and Laird random-effects models.

RESULTS: Four RCTs (n=1149) were included in our meta-analysis. All RCTs only enrolled patients with confirmed STEMI with symptoms lasting <6 or <12hours, and presenting in Killip Class 1 or 2. Mean age ranged across trials from 58.5-62.5years. Most patients were male (range: 74.8%-86.3%). Data suggest that IV beta-blockers may improve LVEF at 0-2weeks (weighted mean difference [WMD]: 1.9%; 95% confidence interval [CI]: -0.7%, 4.5%) and 4-6weeks (WMD: 1.4%; 95% CI: -3.1%, 5.9%) post-infarct, reaching statistical significance at 24weeks (WMD: 2.6%; 95% CI: 0.6%, 4.6%). Rates of ventricular arrhythmia (risk ratio [RR]: 0.65; 95% CI: 0.33, 1.29), any arrhythmia (RR: 0.67; 95% CI: 0.36, 1.27), and cardiogenic shock (RR: 0.77; 95% CI: 0.31, 1.95) during index hospitalization were numerically lower with IV beta-blockers, but 95% CIs were wide.

CONCLUSIONS: In STEMI patients presenting in Killip Class 1 or 2, IV beta-blockers in conjunction with PCI are associated with improved LVEF at 24weeks relative to PCI alone.

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