Schultheiss Heinz-Peter, Tschöpe Carsten
Abteilung für Kardiologie und Pulmologie, Medizinische Klinik II, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin.
Herz. 2002 Aug;27 Suppl 1:26-9.
In the 80s, randomized clinical studies and overviews have shown that adjunctive therapy with beta blockers can be beneficial post-myocardial infarction (MI). Despite this evidence, the use of beta blockers in the post-MI setting is far from uniform and now lags considerably behind the routine use of angiotensin-converting enzyme inhibitors (ACEIs) in this clinical setting. Given the major advances in the management of myocardial infarction and its sequelae that have occurred in the last two decades (including the use of percutaneous transluminal coronary angioplasty [PTCA], thrombolysis, aspirin, ACEIs, and statins), there was clearly a need to revisit the issue of beta blocker therapy in patients with beta blockers in the setting of post-MI heart failure. For all these reasons, the CAPRICORN trial of carvedilol in post-MI left ventricular dysfunction was an important and eagerly awaited trial, which could show that carvedilol treatment post-MI on top of the so-called modern post-MI therapy reduces mortality. Further studies have to show whether this results can be repeated with other beta blockers.
20世纪80年代，随机临床研究及综述表明，心肌梗死（MI）后使用β受体阻滞剂进行辅助治疗可能有益。尽管有这些证据，但β受体阻滞剂在心肌梗死后的应用远未统一，目前在这一临床环境中的使用情况大大落后于血管紧张素转换酶抑制剂（ACEIs）的常规使用。鉴于过去二十年来心肌梗死及其后遗症的管理取得了重大进展（包括经皮腔内冠状动脉成形术[PTCA]、溶栓、阿司匹林、ACEIs和他汀类药物的使用），显然有必要重新审视心肌梗死后心力衰竭患者使用β受体阻滞剂治疗的问题。出于所有这些原因，卡维地洛治疗心肌梗死后左心室功能障碍的CAPRICORN试验是一项重要且备受期待的试验，该试验可能表明，在所谓的现代心肌梗死后治疗基础上加用卡维地洛治疗心肌梗死可降低死亡率。进一步的研究必须表明，其他β受体阻滞剂是否能重复这一结果。
