The effect of carvedilol in patients with impaired left ventricular systolic function following an acute myocardial infarction: How do the treatment effects on total mortality and recurrent myocardial infarction in CAPRICORN compare with previous beta-blocker trials?

doi:10.1016/S1388-9842(02)00099-5

European Journal of Heart Failure 2002 4(4):501-506; doi:10.1016/S1388-9842(02)00099-5

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The effect of carvedilol in patients with impaired left ventricular systolic function following an acute myocardial infarction

How do the treatment effects on total mortality and recurrent myocardial infarction in CAPRICORN compare with previous beta-blocker trials?

Jan Erik Otterstad^a^,* and Ian Ford^b

^a Division of Cardiology, Vestfold Central Hospital N-3116 Toensberg, Norway
^b Robertson Centre for Biostatisics, University of Glasgow Glasgow, Scotland, UK

^* Corresponding author. Tel.: +47-333-42634; fax: +47-333-10623. E-maill address:j-otte{at}online.no

Abstract

In previous beta-blocker trials, post-myocardial infarction(MI) patients were essentially treated with a beta-blocker orplacebo. In the CAPRICORN trial, patients were selected on thebasis of a left ventricular (LV) ejection fraction (EF) <40%following the index MI and randomised to carvedilol or placebo,in addition to modern secondary prophylaxis with ACE inhibitors,aspirin and statins. In 1959 patients with a mean LVEF of 33%,treatment with carvedilol over a mean follow-up period of 15months reduced total mortality from 15.3% with placebo to 11.9%with carvedilol [relative risk reduction (RRR) =23%, absoluterisk reduction (ARR) =3.4%]. The incidence of recurrent MI wasreduced from 5.8 to 2.3% (RRR 41%, ARR 2.3%). The number neededto treat (NNT) to prevent one death was 28 for the entire studyperiod and 43 for 1 year of treatment. The results of the CAPRICORNtrial are compared with three previous beta-blocker post-MItrials: the Gothenburg metoprolol trial (GMT), the Norwegiantimolol trial (NTT) and the beta-blocker heart attack trial(BHAT). The RRRs for total mortality were 36% in the GMT andNTT, and 27% in BHAT. The respective NNTs for total mortalitywere 32, 18 and 38. NNT for 1 year of treatment was 25 in NTTand 80 in BHAT. The RRR for recurrent MIs were 28% in NTT and16% in BHAT. The reduction of mortality and recurrent MIs inCAPRICORN is within the range of previous post-MI beta-blockerstudies. In post-MI patients with LVEF<40%, add-on treatmentwith a beta-blocker should be given >48 h after initiationwith an angiotensin-converting enzyme inhibitor (ACEI) and thenwith a slow dose escalation as applied in CAPRICORN.

Key Words: CAPRICORN study • Beta-blocker studies post myocardial infarction

Received October 11, 2001; Revised December 17, 2001; Accepted February 22, 2002

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