Abrupt withdrawal of β-blockade therapy in patients with myocardial infarction: Effects on infarct size, left ventricular function, and hospital course

C. H. Croft, R. E. Rude, N. Gustafson, P. H. Stone, W. K. Poole, R. Roberts, H. W. Strauss, D. S. Raabe, L. J. Thomas, A. S. Jaffe

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15 Scopus citations

Abstract

The effects of abrupt withdrawal or continuation of β-blockade therapy during acute myocardial infarction were evaluated in 326 patients participating in the Multicenter Investigation of the Limitation of Infarct Size (MILIS). Thirty-nine patients previously receiving a β-blocker and randomly selected for withdrawal of β-blockers and placebo treatment during infarction (group 1) were compared with 272 patients previously untreated with β-blockers who were also randomly assigned to placebo therapy (group 2). There were no signficant differences between the two groups in MB creatine kinase isoenzyme (15.8 ± 10.9 vs 18.2 ± 14.4 g-eq/m2, respectively) estimates of infarct size, radionuclide-determined left ventricular ejection fractions within 18 hr of infarction (0.44 ± 0.15 vs 0.47 ± 0.16) or 10 days later (0.42 ± 0.14 vs 0.47 ± 0.16), creatine kinase-determined incidence of infarct extention (13% vs 6%), congestive heart failure (43% vs 37%), nonfatal ventricular fibrillation (5% vs 7%), or in-hospital mortality (13% vs 9%). Patients in group 1 had more recurrent ischemic chest pain (p = .002) within the first 24 hr after infarction, but not thereafter. However, this did not appear to be related to a rebound increase in systolic blood pressure, heart rate, or double product. In a separate analysis, 20 propranolol-eligible group 1 patients randomly selected for withdrawal of β-blockade (group 3) were compared with 15 patients randomly selected for continuation of prior β-blockade therapy (group 4). This comparison yielded similar results. These data indicate that the β-blockade withdrawal phenomenon is not a major clinical problem in patients with acute myocardial infarction. β-Blockade therapy can be discontinued abruptly during acute myocardial infarction if clinically indicated.

Original languageEnglish (US)
Pages (from-to)1281-1290
Number of pages10
JournalCirculation
Volume73
Issue number6
DOIs
StatePublished - 1986

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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