IV Beta-Blockers Before PCI Improve In-Hospital Mortality

SAN FRANCISCO, CA—At ACC.13, the American College of Cardiology's 62nd Annual Scientific Session, researchers presented about the in-hospital mortality benefit with use of intravenous (IV) beta-blockers before percutaneous coronary intervention (PCI) early in the course of appropriate patients with ST-elevation myocardial infarction (STEMI).

IV beta-blockers are not usually recommended in the early management of patients with STEMI. However, Saurav Chatterjee, MD, from Brown University and the Providence VAMC, Providence, RI, hypothesized that IV beta-blockers would improve short-term mortality most likely by reducing infarct size.  His team performed a systematic review to determine if early IV beta-blockade would improve the risk of in-hospital mortality and clinical endpoints in patients with acute coronary syndrome (ACS).

Dr. Sardar and his team searched PubMed and EMBASE databases from 1966-2010 for trials that compared study participants (aged >18 years) with ACS with an IV beta-blocker vs. placebo/standard therapy.  Intervention included IV beta-blockers within 12 hours of presentation followed by reperfusion (either fibrinolysis or PCI). The primary outcome was the risk of in-hospital all-cause mortality with maximum follow-up duration of 90 days. In-hospital mortality rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) using a random effects model.

Eight studies were included in this systematic review.  Meta-analyses showed that in-hospital mortality was not reduced with IV beta-blockers administered prior to fibrinolysis (n=6; RR 0.99, 95% CI 0.86-1.14; P=0.86). However, IV beta-blockers administered before PCI (n=2) showed greater in-hospital mortality benefit (RR 0.49, 95% CI 0.33-0.74; P=0.0006) without statistical heterogeneity.

According to the results, Dr. Chatterjee was able to conclude that, “IV beta-blockers do indicate an improvement regarding in-hospital mortality before PCI, but not fibrinolytics, early in the course for appropriate patients with STEMI.”