1023-111 Effects of Propranolol in Patients with Their First Acute Myocardial Infarction and Persistent Electrocardiographic ST Segment Depression in the Beta Blocker Heart Attack Trial

Abstract

The available data suggest that patients (pts) recovering from an acute my ocardial infarction (AMI) who have persistent electrocardiographic (ECG) ST segment depression (STD) are at high risk for future cardiac events when compared with AMI pts without STD. There are little data on the long term effects of medical therapy on acute MI pts with STD. The objectives of this retrospective analysis were to examine in the Beta Blocker Heart Attack Trial (BHAT) the effects of propranolol in this high risk group. Of the 2877 first MI BHAT pts, 656 pts had persistent ECG STD from the time of admission until randomization (9.7 ± 3.1 days after index MI). Of these, 317 pts were randomized to the propranolol and 339 pts to placebo. There were no significant baseline differences (p < 0.05) between the two groups. The median follow up was 24.6 months. Follow-up Events Propranolol Placebo p-value (n = 317) (n = 339) (Cox regression) Overall mortality 7.6% 13.6% 00078 Sudden death 4.7% 9.7% 00094 Definite or probable MI 3.8% 7.7% 0.037 MI andlor mortality 9.2% 17.4% 0.0011 Cox regression analysis, adjusting for baseline variables showed the relative risk of mortality and the relative risk of sudden death were 2.13 (1.22, 3.70) and 2.56 (1.27, 5.26) respectively in the placebo, compared to the propranolol group. It appears that propranolol therapy is effective in reducing cardiac events in pts recovering from an AMI with ECG STD.