Oxprenolol in Myocardial Infarction Survivors: Brief Review of the European Infarction Study Results in the Light of Other Beta-Blocker Post Infarction Trials
The European Infarction Study (EIS) was a multicentre, double-blind, randomized study comparing the effect on survival, cardiac mortality and non-fatal cardiac events of oxprenolol slow release 160 mg b.i.d. with placebo in 1741 patients aged 35 to 69 years surviving acute myocardial infarction. During the one year follow-up there was a 30% difference in the cumulative mortality rate in favor of placebo. In the oxprenolol group the mortality was noted to be higher in patients who were 65–69 years of age. In general, there was a higher incidence of fatal reinfarctions and of sudden death in those, who discontinued study medication.
24-h ECG recordings before randomization in 736 patients revealed a high prevalence of complex ventricular tachydysrhythmias. These patients had a significantly higher one-year mortality. Like other beta-blocking drugs oxprenolol had a weak suppressant effect on ventricular tachydysrhythmias in infarct survivors. The proportion of deaths was noted to be higher in the oxprenolol group to the same relative degree in patients with or without complex tachydysrhythmias.
Reviewing the results of other beta-blocker post infarction trials it is concluded that a protective effect on sudden death in myocardial infarction survivors is related to beta-blockade. Beta-blocking drugs with significant intrinsic sympathomimetic activity, which partly counteracts beta-blockade, might be less effective. High dose oxprenolol treatment might be deleterious to some patients with more enhanced coronary heart disease.
KeywordsAcute Myocardial Infarction Multicenter International Study Myocardial Infarction Survivor Discontinue Study Medication Norwegian Multicentre Study Group
Unable to display preview. Download preview PDF.
- A Multicentre International Study (1975) Improvement in prognosis of myocardial infarction by long-term beta-adrenoceptor blockade using practolol. Br Med J: 735–740Google Scholar
- Australian and Swedish Pindolol Study Group (1983) The effect of pindolol on the two years mortality after complicated myocardial infarction. Eur Heart J 4: 367–375Google Scholar
- Barber JM, Boyle DMcC, Chaturvedi NC, Singh N, Walsh MJ (1976) Practolol in acute myocardial infarction. Acta Med Scand 587 (Suppl): 213–216Google Scholar
- Die Europäische Infarktstudie (1985) Die Bedeutung der quantitativen Analyse von ventrikulären Rhythmusstörungen für die Prognose von Patienten mit Zustand nach Myokardinfarkt. Z Kardiol 74:97 (abstr 345)Google Scholar
- Hansteen V, Moinichen E, Lorentsen E, Andersen A, Strom O, Soiland K, Dyrbekk D, Refsum A-M, Tromsdal A, Knudsen K, Eika C, Bakken J, Smith P, Hoff PI (1982) One year’s treatment with propranolol after myocardial infarction: preliminary report of Norwegian multicentre trial. Br Med J 284:155–161CrossRefGoogle Scholar
- Harrison DC (1983) Beneficial effects of beta blockers: A class action or individual pharmacologic spectrum? Circulation 67–1:77–82Google Scholar
- Lichstein E, Morganroth J, Harrist R, Hubble E, for the BHAT Study Group (1983) Effect of propranolol on ventricular arrhythmia. The Beta-blocker Heart Attack Trial Experience. Circulation 67–1: 5–10Google Scholar
- Manger Cats V, van Capelle FJL, Lie KI, Durrer D (1983) Antiarrhythmic effects of metoprolol in the post-hospital phase of myocardial infarction. Circulation 68–111:275 (abstr)Google Scholar
- Mukhariji J, Rude RE, Poole WK, Gustafson N, Thomas LJ, Strauss HW, Jaffe AS, Muller JE, Roberts R, Raabe DS, Croft CH, Passamani E, Braunwald E, Willerson JT, and the Milis Study Group (1984) Risk factors for sudden death after acute myocardial infarction: Two-year followup. Am J Cardiol 54:31–36CrossRefGoogle Scholar
- Nadamanee K, Singh B, Hendrickson J, Rollett E (1983) Efficacy of three β-antagonists in suppressing premature ventricular contraction: Relevance of mechanism of sudden death reduction in survivors of myocardial infarction. JACC 1 (2): 719 (abstr)Google Scholar
- Roden DM, Wang T, Woosley RL (1984) Antiarrhythmic effects of β-blocking drugs. In: Lucchesi BR, Dingell JV, Schwarz RP (eds) Perspectives in cardiovascular research, Volume 10. Raven Press, New York, pp 95–103Google Scholar
- Ryden L, Ariniego R, Arnaman K, Herlitz J, Hjalmarson A, Holmberg S, Reyes C, Smedgard P, Svedberg K, Vedin A, Waagstein F, Waldenstrom A, Wilhelmsson C, Wedel H, Yamamoto M (1983) A double-blind trial of metoprolol in acute myocardial infarction. Effects on ventricular tachyarrhythmias. New Engl J Med 308: 614–618PubMedCrossRefGoogle Scholar
- Shand DG (1983) Clinical pharmacology of the beta-blocking drugs: Implications for the postinfarction patient. Circulation 67–1: 2–5Google Scholar
- The European Infarction Study Group (1983) Ventricular tachyarrhythmias, β-blocker treatment and mortality after myocardial infarction. Eur Heart J 4 (Suppl E): 57 (abstr)Google Scholar
- The European Infarction Study Group (1984a) Failure of β-blocker treatment to suppress ventricular dysrhythmias in survivors of myocardial infarction. JACC 3 (2): 576 (abstr)Google Scholar
- The European Infarction Study Group (1984b) European Infarction Study (EIS) A secondary prevention study with slow release Oxprenolol after myocardial infarction: Morbidity and mortality. Eur Heart J 5:189–202Google Scholar
- The European Infarction Study Group (1985 a) Effect of Oxprenolol on ventricular arrhythmias. The European Infarction Study Experience. JACC 6 (5): 963–972Google Scholar
- The European Infarction Study Group (1985 b) Unwanted side-effects of oxprenolol in myocardial infarction survivors (in preparation)Google Scholar
- Wilcox RG, Rowley JM, Hampton JR, Mitchell JRA (1980 a) Randomised placebo-controlled trial comparing oxprenolol with disopyramide phosphate in immediate treatment of suspected myocardial infarction. Lancet October 11: 765–769Google Scholar