Because
carvedilol is a unique vasodilating β blocker (BB) exerting
antioxidant activity and pleiotropic effects, it was theorized that it may confer more potent beneficial effects on cardiovascular mortality and morbidity in acute
myocardial infarction (AMI) and
heart failure (HF) settings. A systematic review and meta-analysis was performed of randomized, controlled, direct-comparison trials that included adults receiving
atenolol,
bisoprolol,
metoprolol,
nebivolol, or
carvedilol to evaluate the effects of
carvedilol compared to other BBs on mortality, cardiovascular events, and
hospital readmissions in the setting of AMI or systolic HF. Compared to β(1)-selective BBs used in HF (8 trials, n = 4,563),
carvedilol significantly reduced all-cause mortality (risk ratio 0.85, 95% confidence interval 0.78 to 0.93, p = 0.0006). In 3 trials of patients with AMI (n = 644),
carvedilol significantly reduced all-cause mortality by 45% (fixed-effects model: risk ratio 0.55, 95% confidence interval 0.32 to 0.94, p = 0.03, random-effects model: risk ratio 0.56, 95% confidence interval 0.26 to 1.12, p = 0.10), with no reduction in non-fatal MI (risk ratio 0.61, 95% confidence interval 0.31 to 1.22, p = 0.16). In conclusion,
carvedilol, as compared against
atenolol,
bisoprolol,
metoprolol and
nebivolol in randomized direct comparison trials, significantly reduced all-cause mortality in systolic HF patients. Additionally,
carvedilol significantly reduced all-cause mortality compared with β(1)-selective BBs in AMI patients using the fixed-effects model but not using the random-effects model.