SAFETY OF COMBINED INTRAVENOUS BETA-ADRENERGIC-BLOCKADE (ATENOLOL OR METOPROLOL) AND THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL-INFARCTION

One hundred thirty-one patients presenting with acute myocardial infarction (AMI) a mean of 3 hours after the onset of symptoms were treated with oral aspirin and intravenous thrombolytic therapy followed by heparin. One hundred eleven patients (85%) also received intravenous followed by oral beta-blockers. Twenty-one patients (19%) discontinued the beta-blocker because of complications. Five (4.5%) required the addition of diuretic drugs or converting enzyme inhibitors. Six patients (5%) discontinued the beta-blocker after complete mechanical revascularization, and 1 patient was noncompliant. Long-term treatment continued in 90 patients (69%) over a 2-year follow-up period (average 13 months). There were 3 infarct extensions and 3 reinfarctions (5%). Overall mortality at 2 years was 10%. Intravenous beta-blockers are well tolerated in most patients treated with thrombolytic agents, aspirin and heparin. They may further improve the survival benefit of chronic beta-blocker therapy in the period after AMI.