Therapy

Why?

• Long-term beta-blockers reduce death and reinfarction better than placebo, but patients are more likely to stop medication. There is no clear benefit from short-term beta-blockers. ^a
• Patients who receive beta-blockers immediately compared with after 6 days are less likely to develop recurrent chest pain within 6 days or reinfarct within 6 weeks. There is no clear effect on mortality. ^a
• Stable patients with LV dysfunction who take carvedilol compared with placebo are less likely to die or have a non-fatal myocardial infarction. ^a

Beta-blockers reduce death and reinfarction

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
acute or recent MI a	beta-blockers	control	death at 2 years	11%	0.77 (0.69 to 0.85)	44 (32 to 68)
			reinfarction at 2 years	8%		110 (63 to 330)

Patients on beta-blockers are more likely to stop medication

Patient	Treatment	Comparison	Outcome	CER	ARR (95% CI)	NNH (95% CI)
acute or recent MI a	beta-blockers	control	withdrawal at 2 years	22%	-1.16% (-1.76% to -0.56%)	86 (57 to 180)

Beta-blockers given early reduce recurrent chest pain and reinfarction

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
myocardial infarction a	beta-blockers immediately	beta-blockers at 6 days	fatal or nonfatal reinfarction at 6 days	5.0%	48% (10% to 70%)	42 (23 to 430)
			recurrent chest pain at 6 days	24%	22% (4% to 36%)	19 (11 to 100)
			fatal or nonfatal infarction at 6 weeks	7.1%	38% (4% to 60%)	37 (20 to 350)

Note

• Patients with mild-moderate asthma who take cardioselective beta-blockers have a small initial fall in FEV1 (on average 8%), but are not more likely to report respiratory symptoms. ^a