A. Halkin, G. Stone
Jun 14, 2005
The clinical effects of intravenous β-adrenoreceptor- blocking agents (β-blockers) administered during evolving acute myocardial infarction (AMI) have varied among published studies, depending on whether or not reperfusion therapy was employed. Primary percutaneous coronary intervention (PCI) is accepted as the superior form of reperfusion therapy for AMI if it can be performed by an experienced team in a timely fashion. Intravenous β-blockers are not routinely used in this setting and their role as adjunctive medical therapy to catheter-based reperfusion requires definition. Emerging data strongly indicate that in the absence of cardiogenic shock or specific contra-indications, pre-procedural intravenous β-blockade improves survival and recovery of left ventricular function after primary PCI, and that these effects are modulated by oral β-blocker use at the time of AMI onset. In the absence of contra-indications, the available evidence supports the routine administration of intravenous β-blockers to patients with ST-segment elevation AMI managed by catheter-based reperfusion therapy, especially in patients in whom oral β-blockers were not used before admission. While no data are available on the effects of intravenous β-blocker therapy with catheter-based intervention for acute coronary syndromes other than ST-segment elevation AMI, it is reasonable to apply the aforementioned recommendations regarding primary PCI to these patients as well.