Basu S, Senior R, Raftery E B, Lahiri A
Department of Cardiology, Norwick Park Hospital, Harrow, Middlesex, UK.
Eur Heart J. 1996 Dec;17 Suppl F:43-7. doi: 10.1093/eurheartj/17.suppl_f.43.
The majority of post-myocardial infarction studies with beta-blocking drugs involved earlier generations. Newer drugs of this family with additional vasodilating and free-radical suppression properties, such as carvediol, are now available which may improve the prognosis still further. This double-blind, randomized, placebo-controlled, parallel group study was designed to assess the extent of myocardial ischaemia in clinically stable patients 6 weeks after acute myocardial infarction and thrombolysis, and to determine the influence of carvedilol on ischaemic events during the subsequent 6 months. One hundred and one patients who remained event free at 6 weeks post myocardial infarction underwent rest and exercise thallium-201 (TI-201) imaging. Reversible ischaemia was detected in 70 of the patients and there were 13 events in this group compared to one event in the 31 patients without ischaemia (P = 0.07). Four of the 56 patients on carvedilol and 10 of the 45 on placebo had adverse cardiac events (P = 0.04). In patients with reversible ischaemia carvedilol was more effective in reducing these events than was placebo (P = 0.03). These studies demonstrate that reversible myocardial ischaemia detected by TI-201 imaging is present in a large proportion of clinically stable patients following thrombolysis. In these patients, there is an increased cardiac event rate which is significantly reduced by carvedilol.
大多数关于β受体阻滞剂治疗心肌梗死后情况的研究使用的是较早一代的药物。现在已有该类别的新型药物，如卡维地洛，具有额外的血管舒张和自由基抑制特性，可能会进一步改善预后。这项双盲、随机、安慰剂对照、平行组研究旨在评估急性心肌梗死和溶栓治疗6周后临床稳定患者的心肌缺血程度，并确定卡维地洛对随后6个月缺血事件的影响。101例心肌梗死后6周无事件发生的患者接受了静息和运动铊-201（TI-201）显像。70例患者检测到可逆性缺血，该组发生了13起事件，而31例无缺血患者中发生了1起事件（P = 0.07）。服用卡维地洛的56例患者中有4例、服用安慰剂的45例患者中有10例发生不良心脏事件（P = 0.04）。在有可逆性缺血的患者中，卡维地洛在减少这些事件方面比安慰剂更有效（P = 0.03）。这些研究表明，在溶栓治疗后的大部分临床稳定患者中，TI-201显像检测到存在可逆性心肌缺血。在这些患者中，心脏事件发生率增加，而卡维地洛可显著降低该发生率。
