Abstract |
The benefit of beta-blockers for secondary prevention of death and reinfarction after myocardial infarction (MI) has been conclusively demonstrated in randomized clinical trials. Before the Carvedilol Post- Infarct Survival Control in Left Ventricular Dysfunction Study (CAPRICORN)-a multicenter, multinational, double-blind, randomized, placebo-controlled trial that enrolled 1,959 patients who had an acute MI and a left ventricular ejection fraction of <==0.40-it was not known whether beta-blockers confer additional benefit when used in the context of modern post-MI management (eg, fibrinolytic therapy and primary percutaneous transluminal coronary angioplasty, aspirin, and angiotensin-converting enzyme inhibitors). Patients in CAPRICORN were treated with a maximum dose of 25 mg bid and observed until 633 validated primary end points had occurred. Because the overall mortality was lower than had been predicted, a co-primary end point was adopted that included the original primary end point (all-cause mortality) plus the first of the prespecified secondary end points (all-cause mortality or cardiovascular hospitalizations). A significant 23% reduction in the original primary end point of all-cause mortality was observed. A total of 340 (35%) patients died or had a cardiovascular hospitalization in the carvedilol group versus 367 (37%) in the placebo group. Therefore, the revised primary end point of all-cause mortality or cardiovascular hospitalization was reduced by 8%, which was not statistically significant. Significant reductions in cardiovascular mortality, nonfatal MI, and the combination of all-cause mortality or nonfatal MI were observed. Although statistical significance for the revised primary end point was not reached, CAPRICORN has an important role in guiding future use of beta-blockers in the early post-MI period.
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Authors | Wilson S Colucci |
Journal | The American journal of cardiology
(Am J Cardiol)
Vol. 93
Issue 9A
Pg. 13B-6B
(May 06 2004)
ISSN: 0002-9149 [Print] United States |
PMID | 15144931
(Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)
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Chemical References |
- Adrenergic beta-Antagonists
- Carbazoles
- Propanolamines
- Carvedilol
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Topics |
- Adrenergic beta-Antagonists
(therapeutic use)
- Carbazoles
(therapeutic use)
- Carvedilol
- Double-Blind Method
- Female
- Humans
- Male
- Myocardial Infarction
(complications, drug therapy)
- Propanolamines
(therapeutic use)
- Survival Analysis
- Treatment Outcome
- Ventricular Dysfunction, Left
(complications, drug therapy)
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