ADDITIVE BENEFICIAL-EFFECTS OF BETA-BLOCKERS TO ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS IN THE SURVIVAL AND VENTRICULAR ENLARGEMENT (SAVE)STUDY

Objectives, This study assessed whether treatment with a beta-adrenerg ic blocking agent in addition to the use of the angiotensin-converting enzyme (ACE) inhibitor captopril decreases cardiovascular mortality a nd morbidity in patients with asymptomatic left ventricular dysfunctio n after myocardial infarction (MI) and whether the presence of neurohu moral activation at the time of hospital discharge predicts the effect s of beta-blocker treatment in these patients, Background, Both beta b lockers and ACE inhibitors have been shown to have beneficial effects in patients with left ventricular dysfunction but no overt heart failu re after MI. These patients often have persistent neurohumoral activat ion at the time of hospital discharge, and one would expect that patie nts with activation of the sympathetic nervous system derive the most benefit from treatment with beta-blockers, However, beta-blockers are underutilized in this high risk group of patients, and it is unknown w hether their beneficial effects are additive to those of ACE inhibitor s, Methods. We performed a retrospective analysis of data from the Sur vival and Ventricular Enlargement (SAVE) study and its neurohumoral su bstudy, The relations between beta-blocker use at the time of randomiz ation and neurohumoral activation and the subsequent development of ca rdiovascular events were analyzed by use of Cox proportional hazards m odels controlling for covariates, Results, After adjustment for baseli ne imbalances, beta-blocker use was associated with a significant redu ction in risk of cardiovascular death (30%, 95% confidence interval [C I] 12% to 44%) and development of heart failure (21%, 95% CI 3% to 36% ), but the reduction in recurrent MI (11%, 95% CI 13% to 31%) was not significant, These reductions were independent of the use of captopril , Beta blockers were not found to have a greater effect in patients wi th neurohumoral activation at the time of hospital discharge, Conclusi ons. The beneficial effects of beta blacker use at the time of hospita l discharge in patients with asymptomatic left ventricular dysfunction after MI appear to be additive to those of captopril and other interv entions known to improve prognosis, Neurohumoral activation at the tim e of hospital discharge fails to identify those patients who will deri ve the greatest benefit from treatment with beta-blockers. (C) 1997 by the American College of Cardiology.