Olsson G, Odén A, Johansson L, Sjögren A, Rehnqvist N
Department of Medicine, Karolinska Institutet, Danderyd Hospital, Sweden.
Eur Heart J. 1988 Apr;9(4):365-72. doi: 10.1093/oxfordjournals.eurheartj.a062512.
In a randomized double-blind postinfarction study 301 patients were treated with either metoprolol 100 mg b.i.d. (n = 154) or placebo (n = 147) for three years. After the three-year treatment period the study preparation was gradually withdrawn over one week, followed by another 2-7 year follow-up. Mortality and morbidity data were studied both during the intervention period (reported elsewhere) and over the period following withdrawal of study therapy. During the period following the withdrawal of the trial preparation, there were 16 (14%) and 31 (24%) deaths in the previously placebo and metoprolol groups, respectively (P = 0.10). Corresponding figures for reinfarctions and cerebrovascular events were 15 (13%) vs. 12 (9%) and 14 (12%) vs. 9 (7%) (NS). From a Cox regression analysis taking 13 different variables into account, a model describing the risk for subsequent death was constructed. The model identified the following important variables: sex (relative risk (rr) = 2.4), beta-blocker withdrawal (rr = 2.1), performance on exercise test and digitalis treatment (rr = 2.3, P less than 0.05). The present results, as well as those from other studies, seem to favour continuous postinfarction beta blocker therapy provided that there are no severe side-effects from therapy. Digitalis therapy in postinfarction patients in sinus rhythm may have adverse effects on survival during long-term follow-up.
在一项随机双盲心肌梗死后研究中，301例患者接受了为期三年的治疗，其中154例患者每日两次服用100毫克美托洛尔，147例患者服用安慰剂。三年治疗期结束后，研究制剂在一周内逐渐停用，随后进行了另外2至7年的随访。对干预期（已在其他地方报道）以及研究治疗停药后的死亡率和发病率数据进行了研究。在试验制剂停药后的期间，先前服用安慰剂组和美托洛尔组分别有16例（14%）和31例（24%）死亡（P = 0.10）。再梗死和脑血管事件的相应数字分别为15例（13%）对12例（9%）以及14例（12%）对9例（7%）（无统计学意义）。通过考虑13个不同变量的Cox回归分析，构建了一个描述后续死亡风险的模型。该模型确定了以下重要变量：性别（相对风险（rr）= 2.4）、β受体阻滞剂停药（rr = 2.1）、运动试验表现和洋地黄治疗（rr = 2.3，P<0.05）。目前的结果以及其他研究的结果似乎都支持在无严重治疗副作用的情况下，心肌梗死后持续使用β受体阻滞剂治疗。窦性心律的心肌梗死患者使用洋地黄治疗可能对长期随访期间的生存有不良影响。
