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European Heart Journal 1996 17(Supplement F):43-47; doi:10.1093/eurheartj/17.suppl_F.43
Copyright © 1996 by the European Society of Cardiology.
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© 1996 1996 The European Society of Cardiology

The association between cardiac events and myocardial ischaemia following thrombolysis in acute myocardial infarction and the impact of carvedilol

S. Basu, R. Senior, E. B. Raftery* and A. Lahiri

Correspondence: Dr Avijit Lahiri, MB, BS, MSc, MRCP, FACC, Department of Cardiology, Norwick Park Hospital and Institute of Medical Research, Watford Road, Harrow, Middlesex HA1 3UJ, U.K.

The majority of post-myocardial infarction studies with β-blocking drugs involved earlier generations. Newer drugs of this family with additional vasodilating and free-radical suppression properties, such as carvedilol, are now available which may improve the prognosis still further. This double-blind, randomized, placebo-controlled, parallel group study was designed to assess the extent of myocardial ischaemia in clinically stable patients 6 weeks after acute myocardial infarction and thrombolysis, and to determine the influence of carvedilol on ischaemic events during the subsequent 6 months. One hundred and one patients who remained event free at 6 weeks post myocardial infarction underwent rest and exercise thallium-201 (11-201) imaging. Reversible ischaemia was detected in 70 of the patients and there were 13 events in this group compared to one event in the 31 patients without ischaemia (P=0·07). Four of the 56 patients on carvediol and 10 of the 45 on placebo had adverse cardiac events (P=0·04). in patients with reversible ischaemia carvedilol was more effective in reducing these events than was placebo (P=0·03). These studies demon strate that reversible myocardial ischaemia detected by 11-20 1 imaging is present in a large proportion of clinically stable patients following thrombolysis. In these patients, there is an increased cardiac event rate which is significantly reduced by carvediol.

Key Words: Acute myocardial infarction • thallium imaging • prognosis • carvedilol

* Deceased 17 July 1995.


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