Battle of the beta-blockers: Should doctors prescribe metoprolol or carvedilol after a heart attack?
Metoprolol and carvedilol, two of the most common beta-blockers prescribed after an acute myocardial infarction (AMI), largely benefit patients in the same way, according to new findings published in the American Journal of Cardiology.
There is one key difference, however, when it comes to the treatment of patients with depressed left ventricular ejection fraction (LVEF).
The authors tracked data from the OBTAIN registry, which included more than 7,000 patients AMI treated in the United States and Canada. The analysis included more than 4,000 patients prescribed metoprolol at discharge and more than 1,000 patients prescribed carvedilol. Patients sent home without being prescribed either medication were excluded from the study.
Patients treated with carvedilol were slightly older (a mean patient age of 64.4 compared to 63.3) and had more comorbidities. Mean doses for the two medications “did not significantly differ.”
Overall, the three-year survival estimates were 88.2% for the metoprolol group and 83.5% for the carvedilol group. For patients with an LVEF of 40% or lower, carvedilol was associated with “improved survival.” For patients with an LVEF higher than 40%, on the other hand, “there were no differences in survival.”
“Our results suggest that outcomes with carvedilol may be superior to metoprolol only in patients with left ventricular ejection fraction ≤ 40%,” wrote first author Ghaith Zaatari, MD, of the University of Miami Miller School of Medicine, and colleagues. “Further validation of these findings with prospective trials is warranted.”
Read the full analysis here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.