Cochrane for Clinicians

Putting Evidence into Practice

Beta Blockers for Suspected or Diagnosed Acute Myocardial Infarction

 

Clinical Question

Is beta-blocker administration beneficial in the setting of acute myocardial infarction (MI)?

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SUMMARY TABLE

Beta Blockers vs. Placebo or No Intervention for Patients with Suspected or Confirmed MI

OutcomesProbable outcome with beta-blocker administrationProbable outcome with placebo or no treatmentNNT (95% CI)Participants (studies)Evidence quality

Short-term MI risk (within three months)

23 per 1,000 (98% CI, 21 to 25)

28 per 1,000

196 (143 to 333)

67,562 (18 RCTs)

Moderate

Long-term MI risk (six to 60 months)

83 per 1,000 (98% CI, 69 to 99)

92 per 1,000

NA

6,825 (14 RCTs)

Low

Long-term cardiovascular mortality risk (six to 24 months)

112 per 1,000 (98% CI, 103 to 122)

124 per 1,000

83 (48 to 500)

22,457 (14 RCTs)

Moderate

Long-term all-cause mortality risk (six to 60 months)

138 per 1,000 (97.5% CI, 127 to 147)

148 per 1,000

91 (48 to 1,000)

25,210 (21 RCTs)

Moderate


MI = myocardial infarction; NA = not applicable (no statistical difference in outcomes); NNT = number needed to treat; RCT = randomized controlled trial.

SUMMARY TABLE

Beta Blockers vs. Placebo or No Intervention for Patients with Suspected or Confirmed MI

OutcomesProbable outcome with beta-blocker administrationProbable outcome with placebo or no treatmentNNT (95% CI)Participants (studies)Evidence quality

Short-term MI risk (within three months)

23 per 1,000 (98% CI, 21 to 25)

28 per 1,000

196 (143 to 333)

67,562 (18 RCTs)

Moderate

Long-term MI risk (six to 60 months)

83 per 1,000 (98% CI, 69 to 99)

92 per 1,000

NA

6,825 (14 RCTs)

Low

Long-term cardiovascular mortality risk (six to 24 months)

112 per 1,000 (98% CI, 103 to 122)

124 per 1,000

83 (48 to 500)

22,457 (14 RCTs)

Moderate

Long-term all-cause mortality risk (six to 60 months)

138 per 1,000 (97.5% CI, 127 to 147)

148 per 1,000

91 (48 to 1,000)

25,210 (21 RCTs)

Moderate


MI = myocardial infarction; NA = not applicable (no statistical difference in outcomes); NNT = number needed to treat; RCT = randomized controlled trial.

Evidence-Based Answer

Compared with placebo, beta-blocker use in patients with acute MI reduces short-term (less than three months) risk of MI (number needed to treat [NNT] = 196; 95% CI, 143 to 333) and long-term (more than three months) risk of cardiovascular mortality (NNT = 83; 95% CI, 48 to 500) and all-cause mortality (NNT = 91; 95% CI, 48 to 1,000). There are no significant harms.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Heart disease was the leading cause of death in the United States in 2018, according to data from the Centers for Disease Control and Prevention.2 Among the contributors to death from heart disease are the acute coronary syndromes, which include ST elevation MI (STEMI), non–ST elevation MI (NSTEMI), and unstable angina. This Cochrane review examined whether beta-blocker administration in the acute or subacute phase after MI impacts morbidity and/or mortality.1

The authors included 63 randomized controlled trials and 85,550 patients and evaluated the use of beta blockers compared with placebo or no intervention in people with suspected or acute MI. Trials were conducted between 1966 and 2018 in 31 countries, including 15 trials in the United Kingdom and four in the United States. The mean patient age was 57.4 years (range = 45.9 to 70.0 years), and 25.5% of participants were women. Fifty-six trials examined beta-blocker

References

show all references

1. Safi S, Sethi NJ, Nielsen EE, et al. Beta-blockers for suspected or diagnosed acute myocardial infarction. Cochrane Database Syst Rev. 2019;(12):CD012484....

2. Xu J, Murphy SL, Kochanek KD, et al. Mortality in the United States, 2018. NCHS Data Brief no. 355, January 2020. Accessed July 2020. https://www.cdc.gov/nchs/data/databriefs/db355-h.pdf

3. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in J Am Coll Cardiol. 2014;64(24):2713–2714]. J Am Coll Cardiol. 2014;64(24):e139–e228.

4. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78–e140.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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