Utility of Intravenous beta-Blocker Administration in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Intervention

摘要

The clinical effects of intravenous beta-adrenoreceptor-blocking agents (beta-blockers) administered during evolving acute myocardial infarction (AMI) have varied among published studies, depending on whether or not reperfu-sion 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 (3-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 beta-blockade improves survival and recovery of left ventricular function after primary PCI, and that these effects are modulated by oral beta-blocker use at the time of AMI onset. In the absence of contra-indications, the available evidence supports the routine administration of intravenous beta-blockers to patients with ST-segment elevation AMI managed by catheter-based reperfusion therapy, especially in patients in whom oral beta-blockers were not used before admission. While no data are available on the effects of intravenous beta-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.