Effects of carvedilol early after myocardial infarction: analysis of the first 30 days in Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN).

Author(s): Fonarow GC, Lukas MA, Robertson M, Colucci WS, Dargie HJ

Affiliation(s): Ahmanson-UCLA Cardiomyopathy Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu

Publication date & source: 2007-10, Am Heart J., 154(4):637-44.

Publication type: Multicenter Study; Randomized Controlled Trial

BACKGROUND: In the CAPRICORN trial, carvedilol reduced all-cause mortality by 23% over a mean follow-up of 1.3 years in clinically stabilized post-myocardial infarction (MI) patients with left ventricular dysfunction (LVD) with or without signs of heart failure. This analysis sought to assess the impact of carvedilol within the first 30 days of randomization. METHODS: The effect of carvedilol initiated after acute MI with LVD (n = 975) was compared with the effect of placebo (n = 984) added to other standard-of-care therapies on mortality, fatal or nonfatal infarction, cardiac arrest, and their composite as well as withdrawals for adverse events during the first 30 days of therapy. RESULTS: The carvedilol group experienced a reduction in mortality in the first 30 days (19 vs 33, hazard ratio [HR] 0.58, 95% CI 0.33-1.02); fatal or nonfatal MI (13 vs 23, HR 0.57, 95% CI 0.29-1.12); the composite end point of death, nonfatal MI, or cardiac arrest (31 vs 53, HR 0.58, 95% CI 0.38-0.91); and the composite of all-cause mortality or nonfatal MI (29 vs 51, HR 0.57, 95% CI 0.36-0.90). These effects were similar in direction and magnitude to those observed during the entire trial. The rates of adverse events leading to withdrawal were similar in the carvedilol and placebo groups, except for hypotension. CONCLUSIONS: In clinically stabilized post-MI patients with LVD, there is an early benefit with carvedilol treatment that is similar to that seen during long-term therapy.