Presented at the Society for Academic Emergency Medicine annual meeting, New Orleans, LA, May 15, 2009.
Does the Early Administration of Beta-blockers Improve the In-hospital Mortality Rate of Patients Admitted with Acute Coronary Syndrome?
Version of Record online: 4 JAN 2010
© 2009 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 17, Issue 1, pages 1–10, January 2010
How to Cite
Brandler, E., Paladino, L. and Sinert, R. (2010), Does the Early Administration of Beta-blockers Improve the In-hospital Mortality Rate of Patients Admitted with Acute Coronary Syndrome?. Academic Emergency Medicine, 17: 1–10. doi: 10.1111/j.1553-2712.2009.00625.x
A related commentary appears on page 93.
- Issue online: 4 JAN 2010
- Version of Record online: 4 JAN 2010
- Received July 5, 2009; revision received August 2, 2009; accepted August 3, 2009.
- adrenergic beta-antagonists;
- coronary artery disease;
- chest pain;
- myocardial infarction;
Objectives: Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). This was a systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS.
Methods: The authors searched the PubMed and EMBASE databases for randomized controlled trials from 1965 through May 2009 using a search strategy derived from the following PICO formulation of our clinical question: Patients included adults (18+ years) with an acute or suspected myocardial infarction (MI) within 24 hours of onset of chest pain. Intervention included intravenous or oral beta-blockers administered within 8 hours of presentation. The comparator included standard medical therapy with or without placebo versus early beta-blocker administration. The outcome was the risk of in-hospital death in the intervention groups versus the comparator groups. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. In-hospital mortality rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) between beta-blockers and controls. Statistical analysis was done with Review Manager V5.0.
Results: Eighteen articles (total N = 72,249) met the inclusion/exclusion criteria. For in-hospital mortality, RR = 0.95 (95% CI, 0.90–1.01). In the largest of these studies (n = 45,852), a significantly higher rate (p < 0.0001) of cardiogenic shock was observed in the beta-blocker (5.0%) versus control group (3.9%).
Conclusions: This systematic review failed to demonstrate a convincing in-hospital mortality benefit for using beta-blockers early in the course of patients with an acute or suspected MI.
ACADEMIC EMERGENCY MEDICINE 2010; 17:1–10 © 2010 by the Society for Academic Emergency Medicine