CHAPTER 19 BETA-BLOCKERS IN ACUTE MI: THE COMMIT TRIAL

Early Intravenous then Oral Metoprolol in 45,852 Patients with Acute Myocardial Infarction: Randomized Placebo-controlled Trial

Chen ZM, Pan HC, Chen YP, et al. Lancet. 2005;366(9497):1622–1632

BACKGROUND

Acute myocardial infarction (MI) is the leading cause of death in the United States, with approximately 450,000 people dying from acute MI each year. Although beta-blockers have known benefit in congestive heart failure (CHF), cardiac dysrhythmias, and Hypertension (HTN), their use in the setting of AMI was poorly understood. A number of randomized trials had shown benefit, but almost all were completed before the routine use of fibrinolytic and antiplatelet therapies, and the trials primarily studied low-risk patients. Since fibrinolytic therapy had shown a slight increase in mortality in the first days after symptom onset due to dysrhythmias and cardiac rupture, it was thought that beta-blockers could help suppress these adverse events and improve mortality if used in addition to standard therapy for acute MI.

OBJECTIVES

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