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. 1982 Jan 16;284(6310):155–160. doi: 10.1136/bmj.284.6310.155

One year's treatment with propranolol after myocardial infarction: preliminary report of Norwegian multicentre trial.

V Hansteen, E Møinichen, E Lorentsen, A Andersen, O Strøm, K Søiland, D Dyrbekk, A M Refsum, A Tromsdal, K Knudsen, C Eika, J Bakken Jr, P Smith, P I Hoff
PMCID: PMC1495539  PMID: 6799077

Abstract

A prospective, randomised, double-blind study was performed to compare the effects of propranolol and placebo on sudden cardiac death in a high-risk group of patients who survived acute myocardial infarction. Altogether 4929 patients with definite acute myocardial infarction were screened for inclusion: 574 (11.6%) died before randomisation, and 3795 (77%) were excluded. Five hundred and sixty patients aged 35 to 70 years were stratified into two risk groups and randomly assigned treatment with propranolol 40 mg four times a day or placebo. Treatment started four to six days after the infarction. By one year there had been 11 sudden deaths in the propranolol group and 23 in the placebo group (p less than 0.038, two-tailed test analysed according to the "intention-to-treat" principle). Altogether there were 25 deaths in the propranolol group and 37 in the placebo group (P less than 0.12), with 16 and 21 non-fatal reinfarctions respectively. A quarter of the patients were withdrawn from each group. Withdrawal because of heart failure during the first two weeks of treatment was significantly more common among propranolol-treated patients than among the controls, but thereafter the withdrawal rate was the same. The significant reduction in sudden death was comparable with that after alprenolol, practolol, and timolol, which suggests that the mechanism of prevention is beta-blockade rather than any other pharmacological property of the individual drugs.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahlmark G., Saetre H. Long-term treatment with beta-blockers after myocardial infarction. Eur J Clin Pharmacol. 1976 Jun 15;10(2):77–83. doi: 10.1007/BF00609463. [DOI] [PubMed] [Google Scholar]
  2. Alderman E. L., Coltart D. J., Wettach G. E., Harrison D. C. Coronary artery syndromes after sudden propranolol withdrawal. Ann Intern Med. 1974 Nov;81(5):625–627. doi: 10.7326/0003-4819-81-5-625. [DOI] [PubMed] [Google Scholar]
  3. Andersen M. P., Bechsgaard P., Frederiksen J., Hansen D. A., Jürgensen H. J., Nielsen B., Pedersen F., Pedersen-Bjergaard O., Rasmussen S. L. Effect of alprenolol on mortality among patients with definite or suspected acute myocardial infarction. Preliminary results. Lancet. 1979 Oct 27;2(8148):865–868. doi: 10.1016/s0140-6736(79)92684-9. [DOI] [PubMed] [Google Scholar]
  4. Baber N. S. Clinical experience with beta adrenergic blocking agents in myocardial ischaemia: a dilemma and a challenge. Pharmacol Ther. 1981;13(2):285–320. doi: 10.1016/0163-7258(81)90004-8. [DOI] [PubMed] [Google Scholar]
  5. Baber N. S., Evans D. W., Howitt G., Thomas M., Wilson T., Lewis J. A., Dawes P. M., Handler K., Tuson R. Multicentre post-infarction trial of propranolol in 49 hospitals in the United Kingdom, Italy, and Yugoslavia. Br Heart J. 1980 Jul;44(1):96–100. doi: 10.1136/hrt.44.1.96. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Barber J. M., Boyle D. M., Chaturvedi N. C., Singh N., Walsh M. J. Practolol in acute myocardial infarction. Acta Med Scand Suppl. 1976;587:213–219. doi: 10.1111/j.0954-6820.1976.tb05884.x. [DOI] [PubMed] [Google Scholar]
  7. Denborough M. A., Lovell R. R., Nestel P. J., Goble A. J. Arrhythmias and late sudden death after myocardial infarction. Lancet. 1968 Feb 24;1(7539):386–388. doi: 10.1016/s0140-6736(68)91354-8. [DOI] [PubMed] [Google Scholar]
  8. Freiman J. A., Chalmers T. C., Smith H., Jr, Kuebler R. R. The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial. Survey of 71 "negative" trials. N Engl J Med. 1978 Sep 28;299(13):690–694. doi: 10.1056/NEJM197809282991304. [DOI] [PubMed] [Google Scholar]
  9. Hampton J. R. Presentation and analysis of the results of clinical trials in cardiovascular disease. Br Med J (Clin Res Ed) 1981 Apr 25;282(6273):1371–1373. doi: 10.1136/bmj.282.6273.1371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Julian D. G. The significance and management of ventricular arrhythmias. The Bradshaw Lecture 1979. J R Coll Physicians Lond. 1980 Jan;14(1):17–21. [PMC free article] [PubMed] [Google Scholar]
  11. Kuller L., Lilienfeld A., Fisher R. Epidemiological study of sudden and unexpected deaths due to arteriosclerotic heart disease. Circulation. 1966 Dec;34(6):1056–1068. doi: 10.1161/01.cir.34.6.1056. [DOI] [PubMed] [Google Scholar]
  12. Lown B., Fakhro A. M., Hood W. B., Jr, Thorn G. W. The coronary care unit. New perspectives and directions. JAMA. 1967 Jan 16;199(3):188–198. [PubMed] [Google Scholar]
  13. Mallinson C. N., Bloom S. R., Warin A. P., Salmon P. R., Cox B. A glucagonoma syndrome. Lancet. 1974 Jul 6;2(7871):1–5. doi: 10.1016/s0140-6736(74)91343-9. [DOI] [PubMed] [Google Scholar]
  14. PELL S., D ALONZO C. A. IMMEDIATE MORTALITY AND FIVE-YEAR SURVIVAL OF EMPLOYED MEN WITH A FIRST MYOCARDIAL INFARCTION. N Engl J Med. 1964 Apr 30;270:915–922. doi: 10.1056/NEJM196404302701801. [DOI] [PubMed] [Google Scholar]
  15. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. I. Introduction and design. Br J Cancer. 1976 Dec;34(6):585–612. doi: 10.1038/bjc.1976.220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Reynolds J. L., Whitlock R. M. Effects of a beta-adrenergic receptor blocker in myocardial infarction treated for one year from onset. Br Heart J. 1972 Mar;34(3):252–259. doi: 10.1136/hrt.34.3.252. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Shand D. G. Individualization of propranolol therapy. Med Clin North Am. 1974 Sep;58(5):1063–1069. doi: 10.1016/s0025-7125(16)32102-2. [DOI] [PubMed] [Google Scholar]
  18. Wilcox R. G., Roland J. M., Banks D. C., Hampton J. R., Mitchell J. R. Randomised trial comparing propranolol with atenolol in immediate treatment of suspected myocardial infarction. Br Med J. 1980 Mar 29;280(6218):885–888. doi: 10.1136/bmj.280.6218.885. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Woosley R. L., Kornhauser D., Smith R., Reele S., Higgins S. B., Nies A. S., Shand D. G., Oates J. A. Suppression of chronic ventricular arrhythmias with propranolol. Circulation. 1979 Oct;60(4):819–827. doi: 10.1161/01.cir.60.4.819. [DOI] [PubMed] [Google Scholar]

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