A Cochrane review [Abstract] 1 on effect of early treatment with ACE inhibitors (12 studies), beta-blockers (20 studirs, n=72 600), calcium channel blockers (CCBs) (18) and nitrates (18 studies) on short and long-term mortality in patients with an acute cardiovascular event included 65 studies with a total of 166 206 subjects. Immediate treatment (started within 24 hours of the onset and lasting for maximum 2 days) with beta-blockers was not associated with a statistically significant reduction in all-cause mortality at 2 days (RR 0.95, 95% CI 0.85 to1.07, I2=67%; 6 studies, n=68 007) or at 10 days (RR 1.12, 95% CI 0.60 to 2.07; 6 studies, n=1 143) in patients with acute myocardial infarction. Only one study (N=108) reported mortality at ≥30 days; there were no deaths in either group. Short-term treatment (started within 24 hours of the onset and lasting for a maximum of 10 days) was not associated with a statistically significant reduction in all-cause mortality at 10 days (RR 0.96, 95% CI 0.91 to 1.02; 14 studies, n=71 457) or at ≥ 30 days (during a weighted average of 12 months of follow-up) (RR 0.92, 95% CI 0.85 to 1.00; 5 studies, n=18 373) .
Comment: The quality of evidence is downgraded by study quality (lack of blinding). The findings of this review are not contradictory to the long-term mortality benefits for beta-blockers post myocardial infarction when these drugs are started a few days or weeks after myocardial infarction and continued for some months.
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