Intracranial hemorrhage rates and effect of immediate beta-blocker use in patients with acute myocardial infarction treated with tissue plasminogen activator. Participants in the National Registry of Myocardial Infarction-2.
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine; Department of Medicine, Division of Cardiovascular Medicine
Medical Subject Headings
Adrenergic beta-Antagonists; Aged; California; Cohort Studies; Female; Humans; Intracranial Hemorrhages; Male; Massachusetts; Michigan; Myocardial Infarction; Plasminogen Activators; Registries; Retrospective Studies; Thrombolytic Therapy; Tissue Plasminogen Activator
Health Services Research | Medicine and Health Sciences
In acute myocardial infarction (AMI), immediate beta-blocker therapy reduces the incidence of reinfarction and recurrent chest pain in patients receiving tissue plasminogen activator (t-PA). Data from the Thrombolysis in Myocardial Infarction (TIMI)-2 trial also raises the possibility that such therapy may reduce the rate of intracranial hemorrhage (ICH). We reviewed data obtained from 60,329 patients treated with t-PA who were enrolled in the National Registry of Myocardial Infarction 2. Of the 60,329 in the study cohort, 23,749 patients (39.4%) were treated with immediate beta-blocker therapy and 542 patients (0.9%) developed an ICH. In a multivariate model that included all covariates known to be associated with the development of ICH, immediate beta-blocker therapy was associated with a 31% reduction in the ICH rate (odds ratio 0.69, 95% confidence intervals 0.57 to 0.84). Thus, in the present study, the use of immediate beta-blocker therapy in patients with AMI treated with t-PA was associated with a significant reduction in ICH. This finding supports the observations made in the TIMI 2 trial and serves to reinforce the recommendations made by the American College of Cardiology/American Heart Association task force that immediate beta-blocker therapy should be administered to all patients with AMI who do not have contraindications to this therapy.
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Citation: Am J Cardiol. 2000 Feb 1;85(3):294-8.
Barron, Hal V.; Rundle, Amy Chen; Gore, Joel M.; Gurwitz, Jerry H.; and Penney, Jan, "Intracranial hemorrhage rates and effect of immediate beta-blocker use in patients with acute myocardial infarction treated with tissue plasminogen activator. Participants in the National Registry of Myocardial Infarction-2." (2000). Meyers Primary Care Institute Publications and Presentations. 87.