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Best evidence topic report
Oral or intravenous β blockers in acute myocardial infarction
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  1. Steve Jones,
  2. Ian Crawford
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

http://dx.doi.org/10.1136/emj.18.4.270-a

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    Report by Steve Jones, Clinical Research Fellow Search checked by Ian Crawford, Clinical Research Fellow

    Clinical scenario

    A 45 year old man is brought to the emergency department with acute, central chest pain. You have diagnosed an acute myocardial infarction from the ECG for which he is receiving thrombolysis. You know that giving him a β blocker will improve his outcome but you only have tablets in the department and wonder whether he will be at a disadvantage for receiving this rather than an intravenous dose.

    Three part question

    In [an acute myocardial infarction] is [IV β block better than oral β block] at [reducing mortality and decreasing morbidity]?

    Search strategy

    Medline 1966–12/00 using the OVID interface. [{exp myocardial infarction OR myocardial infarction.mp} AND {exp adrenergic beta-antagonists OR beta blockers.mp} AND {exp administration, oral OR exp oral medicine OR oral.mp}] AND maximally sensitive RCT filter LIMIT to human AND english.

    Search outcome

    Altogether 143 papers found of which 142 were irrelevant or of insufficient quality. The remaining paper is shown in table 1.

    View this table:
    Table 1

    Comments

    Although atenolol seems to improve outcomes after thrombolysis for myocardial infarction, early intravenous atenolol seems of limited value. The best approach for most patients may be to begin oral atenolol once stable. More work will need to be done.

    Clinical bottom line

    Oral β blockers are better than IV β blockers in stable AMI patients.

    Report by Steve Jones, Clinical Research Fellow Search checked by Ian Crawford, Clinical Research Fellow

    References

    1. Pfisterer M, Cox JL, Granger CB, et al. Atenolol use and clinical outcomes after thrombolysis for acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries. J Am Coll Cardiol1998;32:634–40.
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