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PLoS One. 2018 Aug 28;13(8):e0199347. doi: 10.1371/journal.pone.0199347. eCollection 2018.

Long-term use of carvedilol in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

Author information

1
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
2
Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan.
3
Division of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
4
Division of Cardiology, Tenri Hospital, Nara, Japan.
5
Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
6
Division of cardiology, Shiga General Hospital, Moriyama, Japan.
7
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
8
Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan.
9
Division of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
10
Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
11
Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan.
12
Division of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
13
Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
14
Division of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan.
15
Division of Cardiology, Nagoya Tokushukai General Hospital, Kasugai, Japan.
16
Division of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
17
Division of Cardiology, Kawakita General Hospital, Tokyo, Japan.
18
Division of Cardiology, Chikamori Hospital, Kochi, Japan.
19
Division of Cardiology, Yotsuba Circulation Clinic, Matsuyama, Japan.
20
Division of Cardiology, Hoshi General Hospital, Koriyama, Japan.
21
Division of Cardiology, New Tokyo Hospital, Chiba, Japan.

Abstract

BACKGROUND:

Despite its recommendation by the current guidelines, the role of long-term oral beta-blocker therapy has never been evaluated by randomized trials in uncomplicated ST-segment elevation myocardial infarction (STEMI) patients without heart failure, left ventricular dysfunction or ventricular arrhythmia who underwent primary percutaneous coronary intervention (PCI).

METHODS AND RESULTS:

In a multi-center, open-label, randomized controlled trial, STEMI patients with successful primary PCI within 24 hours from the onset and with left ventricular ejection fraction (LVEF) ≥40% were randomly assigned in a 1-to-1 fashion either to the carvedilol group or to the no beta-blocker group within 7 days after primary PCI. The primary endpoint is a composite of all-cause death, myocardial infarction, hospitalization for heart failure, and hospitalization for acute coronary syndrome. Between August 2010 and May 2014, 801 patients were randomly assigned to the carvedilol group (N = 399) or the no beta-blocker group (N = 402) at 67 centers in Japan. The carvedilol dose was up-titrated from 3.4±2.1 mg at baseline to 6.3±4.3 mg at 1-year. During median follow-up of 3.9 years with 96.4% follow-up, the cumulative 3-year incidences of both the primary endpoint and any coronary revascularization were not significantly different between the carvedilol and no beta-blocker groups (6.8% and 7.9%, P = 0.20, and 20.3% and 17.7%, P = 0.65, respectively). There also was no significant difference in LVEF at 1-year between the 2 groups (60.9±8.4% and 59.6±8.8%, P = 0.06).

CONCLUSION:

Long-term carvedilol therapy added on the contemporary evidence-based medications did not seem beneficial in selected STEMI patients treated with primary PCI.

TRIAL REGISTRATION:

CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in Large-scale Randomized Controlled Trial) ClinicalTrials.gov.number, NCT 01155635.

PMID:
30153268
PMCID:
PMC6112626
DOI:
10.1371/journal.pone.0199347
[Indexed for MEDLINE]
Free PMC Article

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