Possible Survival Benefit from Concomitant Beta-but Not Calcium-Antagonist Therapy During Reperfusion for Acute

To test the hypothesis that long-term /3- or cakium-antagonist therapy begun before the time of myo-cardial infarction and coronary reperfusion might improve patient in-hospital survival compared with reperfusion alone, 424 consecutive patients suc-cessfully reperfused with coronary angioplasty within 12 hours of infarct symptom onset were carefully and retrospectively characterized. Forty-seven patients (11%) were taking #? antagonists and 74 patients (17%) were taking calcium antago-nists at the time of infarction. Patients receiving f9 antagonists had a more frequent history of hyper-tension (p lO.001) and prior infarction (p 10.01) than those not so treated and patients receiving cakium antagonists had a more frequent history of prior infarction, prior angina, hypertension and dia-betes (all p 50.001) than their nontreated counter-parts. Stepwise logistic regression analysis found significant independent correlations between in-hospital death and the following variables: recur-rent ischemia (p 50.001); proximal left anterior descending coronary infarct (p lO.001); 3-vessel disease (p = 0.002); patient age (p = 0.004); and initial total occlusion of the infarct artery (p = 0.022). After adjustment for these factors, p an-tagonist use (mortality = 0 vs 8 % without treat-ment) was still signifkantly correlated with im-proved survival (p = O.O4S), whereas cakium-an-tagonist therapy made no difference in survival. Heart rate and left ventricular end-diastolic pres-sure upon presentation were significantly lower in patients treated with @ antagonists. Thus, &antag-onist therapy, but probably not calcium-antagonist therapy, taken before reperfusion for acute myo