Effects of propranolol in non-Q-wave acute myocardial infarction in the Beta Blocker Heart Attack Trial

Although the beneficial effects of long-term therapy with β-adrenergic blocking agents in patients recovering from acute myocardial infarction (AMI) are established, the effect of this therapy on the cardiac event rate in patients recovering from a non-Q-wave AMI is unknown. This post hoc analysis of the Beta Blocker Heart Attack Trial (BHAT) evaluates the effects of daily administration of propranolol 180 or 240 mg/day after non-Q-wave AMI. The study population consisted of 601 patients with enzymatically proven non-Q-wave AMI, which represented 17% of the BHAT patients. Of these, 310 patients were randomized to receive propranolol and 291 patients to placebo. There were no significant baseline differences between groups. The median follow-up was 24.6 months. Mortality was 7.8% (sudden death 4.8%) in the propranolol group and 7.9% (sudden death 4.8%) in the placebo group (p >0.99, log rank test). Reinfarction rate was 7.4% in the propranolol group and 6.5% in the placebo group (p >0.63, log rank test). The need for coronary bypass surgery was similar in the 2 groups. However, more patients randomized to placebo developed angina. In this post hoc group analysis of the BHAT, propranolol was not shown to be beneficial in reducing the cardiac event rate in patients recovering from a non-Q-wave AMI.