Additive effects of ß-blockers on renin-angiotensin system inhibitors for patients after acute myocardial infarction treated with primary coronary revascularization.

BACKGROUND: Although some ß-blockers are effective for patients after acute myocardial infarction (AMI), few studies have compared their additive effects on renin-angiotensin system inhibitors (RAS-Is). METHODS AND RESULTS: The 251 consecutive AMI patients administered angiotensin-converting-enzyme inhibitors (ACE-Is) or angiotensin-II receptor blockers (ARBs) were retrospectively investigated and divided into 2 groups: treated without ß-blockers (no-ß-blocker group, n=80) or treated with ß-blockers before discharge (ß-blocker group, n=171; carvedilol [n=91] or bisoprolol [n=80]). The doses of RAS-Is used for patients in the no-ß-blocker group were at least double those used in the ß-blocker group. No significant differences between the 2 groups were observed with regard to baseline characteristics. After a 12-month follow-up, the survival and cardiac event-free rates in the ß-blocker group were significantly higher than those in the no-ß-blocker group. The percent change in blood pressure did not significantly differ between the 2 groups, but the levels of brain natriuretic peptide, metalloproteinase-2, and metalloproteinase-9 and the left ventricular ejection fraction improved significantly in the ß-blocker group compared with the no-ß-blocker group. Regarding the 2 ß-blockers, carvedilol treatment produced more favorable outcomes than bisoprolol. CONCLUSIONS: The data suggest that treatment with RAS-I in combination with ß-blocker is more effective for patients after AMI than treatment with RAS-I alone.