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

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.

• Authors: Hiroki Watanabe, Neiko Ozasa, Takeshi Morimoto, Hiroki Shiomi, Bao Bingyuan, Satoru Suwa, Yoshihisa Nakagawa, Chisato Izumi, Kazushige Kadota, Shigeru Ikeguchi, Kiyoshi Hibi, Yutaka Furukawa, Shuichiro Kaji, Takahiko Suzuki, Masaharu Akao, Tsukasa Inada, Yasuhiko Hayashi, Mamoru Nanasato, Masaaki Okutsu, Ryosuke Kametani, Takahito Sone, Yoichi Sugimura, Kazuya Kawai, Mitsunori Abe, Hironori Kaneko, Sunao Nakamura, Takeshi Kimura, CAPITAL-RCT investigators
• Journal: PloS one (PLoS One) Vol. 13 Issue 8 Pg. e0199347 ( 2018) ISSN: 1932-6203 [Electronic] United States
• PMID: 30153268 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Carvedilol

Topics

• Aged
• Carvedilol (therapeutic use)
• Combined Modality Therapy
• Female
• Humans
• Male
• Middle Aged
• Percutaneous Coronary Intervention
• ST Elevation Myocardial Infarction (drug therapy, surgery)
• Time Factors
• Treatment Outcome