CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION
Antiarrhythmic effect of carvedilol after acute myocardial infarction
Results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial
John McMurray, MD*,*,
Lars Køber, MD ,
Michele Robertson, BSc ,
Henry Dargie, MB, ChB*,
Wilson Colucci, MD ,
Jose Lopez-Sendon, MD||,
Willem Remme, MD¶,
D. Norman Sharpe, MD# and
Ian Ford, PhD
* Department of Cardiology, Western Infirmary, Glasgow, United Kingdom
Department of Cardiology, Gentoffe University Hospital, Copenhagen, Denmark
Robertson Centre for Biostatistics, University of Glasgow; Glasgow, United Kingdom
Boston University Medical Center, Boston, Massachusetts
|| Department of Cardiology, Hospital University, Madrid, Spain
¶ Sticares Foundation, Rhoon, the Netherlands
# Department of Medicine, University of Auckland, Auckland, New Zealand
Manuscript received June 2, 2003;
revised manuscript received August 26, 2004,
accepted September 2, 2004.
* Reprint requests and correspondence: Prof. John J. V. McMurray, Department of Cardiology, Western Infirmary, Glasgow, G11 6NT, United Kingdom (Email: j.mcmurray{at}bio.gla.ac.uk).
OBJECTIVES: Whether beta-blockers reduce atrial arrhythmias and, when added to an angiotensin-converting enzyme (ACE) inhibitor, ventricular arrhythmia is unknown.
BACKGROUND: Ventricular and atrial arrhythmias are common after acute myocardial infarction (AMI) and are associated with a poor prognosis. Angiotensin-converting enzyme inhibitors reduce the incidence of both types of arrhythmia.
METHODS: The antiarrhythmic effect of carvedilol was examined in a placebo-controlled multicenter trial, the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) study, which enrolled 1,959 patients with reduced left ventricular systolic function after AMI, 98% of whom were treated with an ACE inhibitor.
RESULTS: The incidence of atrial fibrillation/flutter was 53 to 984 (5.4%) in the placebo group and 22 to 975 (2.3%) in the carvedilol group, giving a carvedilol/placebo hazard ratio (HR) of 0.41 (95% confidence interval [CI] 0.25 to 0.68; p = 0.0003). The corresponding rates of ventricular tachycardia/flutter/fibrillation were 38 to 984 (3.9%) and 9 to 975 (0.9%) (HR 0.24, 95% CI 0.11 to 0.49; p < 0.0001).
CONCLUSIONS: Carvedilol has a powerful antiarrhythmic effect after AMI, even in patients already treated with an ACE inhibitor. Carvedilol suppresses atrial as well as ventricular arrhythmias in these patients.
|
Abbreviations and Acronyms
| | ACE = angiotensin-converting enzyme | | AE = adverse event | | AF = atrial fibrillation | | CAPRICORN = Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction trial | | CI = confidence interval | | DIAMOND-MI = Danish Investigations of Arrhythmia and Mortality on Dofetilide-Myocardial Infarction study | | HR = hazard ratio | | MI = myocardial infarction | | SAE = serious adverse event | | TRACE = Trandolapril Cardiac Evaluation study |
|
Related Article
-
Three decades of clinical trials with beta-blockers: The contribution of the CAPRICORN trial and the effect of carvedilol on serious arrhythmias
- Craig M. Pratt
J. Am. Coll. Cardiol. 2005 45: 531-532.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
J. Schmitt, G. Duray, B. J. Gersh, and S. H. Hohnloser
Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications
Eur. Heart J.,
May 1, 2009;
30(9):
1038 - 1045.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Cappato
Atrial fibrillation complicating acute myocardial infarction: how should it be interpreted and how should it be treated and prevented?
Eur. Heart J.,
May 1, 2009;
30(9):
1035 - 1037.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al.
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
J. Am. Coll. Cardiol.,
April 14, 2009;
53(15):
e1 - e90.
[Full Text]
[PDF]
|
|
|
|
|
|
|
2005 WRITING COMMITTEE MEMBERS, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, et al.
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation
Circulation,
April 14, 2009;
119(14):
e391 - e479.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. G. Cosio, E. Aliot, G. L. Botto, H. Heidbuchel, C. J. Geller, P. Kirchhof, J.-C. De Haro, R. Frank, J. P. Villacastin, J. Vijgen, et al.
Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode
Europace,
January 1, 2008;
10(1):
21 - 27.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-R. Neuberger, C. Mewis, D. J. van Veldhuisen, U. Schotten, I. C. van Gelder, M. A. Allessie, and M. Bohm
Management of atrial fibrillation in patients with heart failure
Eur. Heart J.,
November 1, 2007;
28(21):
2568 - 2577.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. J. Schwartz and E. Vanoli
From exercise training to sudden death prevention via adrenergic receptors
Am J Physiol Heart Circ Physiol,
November 1, 2007;
293(5):
H2631 - H2633.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Kloner and D. S. Cannom
Uncertainty on the Use of Aldosterone Antagonists for Primary Therapy for Sudden Cardiac Death in the Setting of Implanted Devices
Circulation,
June 12, 2007;
115(23):
2983 - 2989.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Rivard, H. Sinno, A. Shiroshita-Takeshita, G. Schram, T.-K. Leung, and S. Nattel
The pharmacological response of ischemia-related atrial fibrillation in dogs: Evidence for substrate-specific efficacy
Cardiovasc Res,
April 1, 2007;
74(1):
104 - 113.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. J. Remme, C. Torp-Pedersen, J. G.F. Cleland, P. A. Poole-Wilson, M. Metra, M. Komajda, K. Swedberg, A. Di Lenarda, P. Spark, A. Scherhag, et al.
Carvedilol Protects Better Against Vascular Events Than Metoprolol in Heart Failure: Results From COMET
J. Am. Coll. Cardiol.,
March 6, 2007;
49(9):
963 - 971.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Dobre, D. J. van Veldhuisen, M. J.L. DeJongste, C. Lucas, G. Cleuren, R. Sanderman, A. V. Ranchor, and F. M. Haaijer-Ruskamp
Prescription of beta-blockers in patients with advanced heart failure and preserved left ventricular ejection fraction. Clinical implications and survival
Eur J Heart Fail,
March 1, 2007;
9(3):
280 - 286.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. A. Nasr, A. Bouzamondo, J.-S. Hulot, O. Dubourg, J.-Y. Le Heuzey, and P. Lechat
Prevention of atrial fibrillation onset by beta-blocker treatment in heart failure: a meta-analysis
Eur. Heart J.,
February 8, 2007;
(2007)
ehl484v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. M. Southerland, D. M. Milhorn, R. D. Foreman, B. Linderoth, M. J. L. DeJongste, J. A. Armour, V. Subramanian, M. Singh, K. Singh, and J. L. Ardell
Preemptive, but not reactive, spinal cord stimulation mitigates transient ischemia-induced myocardial infarction via cardiac adrenergic neurons
Am J Physiol Heart Circ Physiol,
January 1, 2007;
292(1):
H311 - H317.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
651 - 745.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol.,
August 15, 2006;
48(4):
e149 - e246.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation,
August 15, 2006;
114(7):
e257 - e354.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. van Veldhuisen, H. Aass, D. El Allaf, P. H.J.M. Dunselman, L. Gullestad, M. Halinen, J. Kjekshus, L. Ohlsson, H. Wedel, J. Wikstrand, et al.
Presence and development of atrial fibrillation in chronic heart failure: Experiences from the MERIT-HF Study
Eur J Heart Fail,
August 1, 2006;
8(5):
539 - 546.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. R. Hanna, B. Heeke, H. Bush, L. Brosius, D. King-Hageman, J. F. Beshai, and J. J. Langberg
The Relationship Between Stature and the Prevalence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction
J. Am. Coll. Cardiol.,
April 18, 2006;
47(8):
1683 - 1688.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Molenaar, T. Christ, U. Ravens, and A. Kaumann
Carvedilol blocks {beta}2- more than {beta}1-adrenoceptors in human heart
Cardiovasc Res,
January 1, 2006;
69(1):
128 - 139.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. N. Singh
{beta}-Adrenergic Blockers as Antiarrhythmic and Antifibrillatory Compounds: An Overview
Journal of Cardiovascular Pharmacology and Therapeutics,
October 1, 2005;
10(4_suppl):
S3 - S14.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. H. Hohnloser
Ventricular Arrhythmias: Antiadrenergic Therapy for the Patient with Coronary Artery Disease
Journal of Cardiovascular Pharmacology and Therapeutics,
October 1, 2005;
10(4_suppl):
S23 - S31.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G. V. Naccarelli
Antiadrenergic Therapy in the Control of Atrial Fibrillation
Journal of Cardiovascular Pharmacology and Therapeutics,
October 1, 2005;
10(4_suppl):
S33 - S43.
[Abstract]
[PDF]
|
|
|
|
|
|
|
P. R. Kowey
A Review of Carvedilol Arrhythmia Data in Clinical Trials
Journal of Cardiovascular Pharmacology and Therapeutics,
October 1, 2005;
10(4_suppl):
S59 - S68.
[Abstract]
[PDF]
|
|
|
|
|
|
|
Developed in Collaboration With the American Colle, Endorsed by the Heart Rhythm Society, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, et al.
ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure)
J. Am. Coll. Cardiol.,
September 20, 2005;
46(6):
1116 - 1143.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al.
ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society
Circulation,
September 20, 2005;
112(12):
1825 - 1852.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Lehman
Evidently...
Evid. Based Med.,
August 1, 2005;
10(4):
105 - 105.
[Full Text]
[PDF]
|
|
|
|
