Haïat R, Roussin I, Leroy G
Service de cardiologie et urgences cardiovasculaires, Centre hospitalier général, Saint-Germain-en-Laye.
Arch Mal Coeur Vaiss. 1992 Nov;85(11 Suppl):1697-702.
Beta-blockers have been used after myocardial infarction since 1965: however, it was not until the beginning of the 80s that the large multicentre clinical trials published results showing clearly their beneficial effects and leading to their widespread usage: betablockers significantly reduce the medium term (1 to 3 years) risk of death (-22 to -24%), especially sudden death (-32%) and the frequency of recurrent infarction (-27%). The cardio-protection so obtained is multifactorial, essentially related to their antiarrhythmic, antiischemic and antihypertensive effects. It has been established that beta-blockade should be instituted as soon as possible in the hours following the infarct (intravenous relayed by oral administration) and may be useful associated with aspirin. Although the large scale clinical trials did not determine the optimal dosage or the duration for which treatment should be administered, they did show that the groups of high risk patients were those to benefit the most from this therapy. Beta-blockers are usually well tolerated. However, it must be pointed out that 18% of patients were excluded from the two principal trials (only 25 to 30% of infarct patients were included) because of contraindications to beta-blockers and that 25 to 30% of the patients initially included had to interrupt the treatment because of side effects.
自1965年起，β受体阻滞剂便开始用于心肌梗死后的治疗：然而，直到80年代初，大型多中心临床试验公布的结果才清楚显示出其有益效果，并促使其广泛应用：β受体阻滞剂可显著降低中期（1至3年）死亡风险（降低22%至24%），尤其是猝死风险（降低32%）以及再发梗死频率（降低27%）。如此获得的心脏保护作用是多因素的，主要与其抗心律失常、抗缺血和降压作用有关。现已确定，应在梗死发生后的数小时内尽快开始β受体阻滞剂治疗（先静脉给药，随后口服给药），且与阿司匹林联合使用可能有益。尽管大规模临床试验未确定最佳剂量或治疗应持续的时间，但确实表明高危患者群体从该治疗中获益最大。β受体阻滞剂通常耐受性良好。然而，必须指出的是，由于β受体阻滞剂的禁忌证，有18%的患者被排除在两项主要试验之外（仅纳入了25%至30%的梗死患者），并且最初纳入的患者中有25%至30%因副作用而不得不中断治疗。
