PLoS ONE (Jan 2018)

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

  • 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

DOI
https://doi.org/10.1371/journal.pone.0199347
Journal volume & issue
Vol. 13, no. 8
p. e0199347

Abstract

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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.