Intracranial hemorrhage rates and effect of immediate beta-blocker use in patients with acute myocardial infarction treated with tissue plasminogen activator

In acute myocardial infarction (AMI), immediate beta-blocker therapy reduce s the incidence of reinfarction and recurrent chest pain in patients receiv ing tissue plasminogen activator (t-PA), Data from the Thrombolysis in Myoc ardial Infarction (TIMI)-2 trial also raises the possibility that such ther apy may reduce the rate of intracranial hemorrhage (ICH). We reviewed data obtained from 60,329 patients treated with t-PA who were enrolled in the Na tional Registry of Myocardial Infarction 2. OF the 60,329 in the study coho rt, 23,749 patients (39.4%) were treated with immediate beta-blocker therap y and 542 patients (0.9%) developed an ICH, In a multivariate model that in cluded all covariates known to be associated with the development of ICH, i mmediate beta-blocker therapy was associated with a 31% reduction in the IC H rate (odds ratio 0.69, 95% confidence intervals 0.57 to 0.84). Thus, in t he present study, the use of immediate beta-blocker therapy in patients wit h AMI treated with t-PA was associated with a significant reduction in ICH, This finding supports the observations made in the TIMI 2 trial and serves to reinforce the recommendations made by the American College of Cardiolog y/American Heart Association task force that immediate beta-blocker therapy should be administered to all patients with AMI who do not have contraindi cations to this therapy. (C)2000 by Excerpta Medica, Inc.