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Does the Early Administration of Beta‐blockers Improve the In‐hospital Mortality Rate of Patients Admitted with Acute Coronary Syndrome?
Author(s) -
Brandler Ethan,
Paladino Lorenzo,
Sinert Richard
Publication year - 2010
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2009.00625.x
Subject(s) - medicine , acute coronary syndrome , confidence interval , myocardial infarction , beta blocker , relative risk , placebo , cardiogenic shock , randomized controlled trial , mortality rate , inclusion and exclusion criteria , heart failure , alternative medicine , pathology
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