SAFETY OF BETA-BLOCKER THERAPY WITH AND WITHOUT THROMBOLYSIS - A COMPARISON OF BISOPROLOL AND ATENOLOL IN ACUTE MYOCARDIAL-INFARCTION

In the current era of widely used thrombolytic therapy, the new betabl ocker bisoprolol was compared with the well-established betablocker at enolol in the treatment of acute myocardial infarction (AMI), A total of 334 patients were enrolled in this international, multicenter, rand omized, double-masked, controlled study of 7 days' duration in two par allel groups, The purpose of the study was to compare the tolerability and safety of the two beta-blockers given to patients with AMIs who e ither were (281 patients) or were not (53) given concurrent thrombolyt ic agents, A statistically significant decrease in heart rate was seen with both bisoprolol and atenolol, Beta-blocker therapy had to be int errupted in 70 patients, 36 receiving bisoprolol and 34 atenolol, beca use of serious adverse effects, The difference in incidence of adverse events between groups was not significant, A logistic regression anal ysis based on conditions at admission predicted an increase in the ris k of critical events occurring during the first week after an AMI for patients with a positive family history of AMI, a moderate-sized myoca rdial infarction, or a heart rate >70 beats/min, and for patients pret reated with dihydropyridine calcium antagonists, Bisoprolol was found to be as effective as atenolol in reducing heart rate, an important go al of intervention in AMI. Furthermore, some characteristics that migh t influence the decision to use beta-blockers in addition to thromboly tic agents were identified.