Clinical research
Acute myocardial infarction
Antiarrhythmic effect of carvedilol after acute myocardial infarction: Results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial

https://doi.org/10.1016/j.jacc.2004.09.076Get rights and content
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Objectives

Whether beta-blockers reduce atrial arrhythmias and, when added to an angiotensin-converting enzyme (ACE) inhibitor, ventricular arrhythmia is unknown.

Background

Ventricular and atrial arrhythmias are common after acute myocardial infarction (AMI) and are associated with a poor prognosis. Angiotensin-converting enzyme inhibitors reduce the incidence of both types of arrhythmia.

Methods

The antiarrhythmic effect of carvedilol was examined in a placebo-controlled multicenter trial, the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) study, which enrolled 1,959 patients with reduced left ventricular systolic function after AMI, 98% of whom were treated with an ACE inhibitor.

Results

The incidence of atrial fibrillation/flutter was 53 to 984 (5.4%) in the placebo group and 22 to 975 (2.3%) in the carvedilol group, giving a carvedilol/placebo hazard ratio (HR) of 0.41 (95% confidence interval [CI] 0.25 to 0.68; p = 0.0003). The corresponding rates of ventricular tachycardia/flutter/fibrillation were 38 to 984 (3.9%) and 9 to 975 (0.9%) (HR 0.24, 95% CI 0.11 to 0.49; p < 0.0001).

Conclusions

Carvedilol has a powerful antiarrhythmic effect after AMI, even in patients already treated with an ACE inhibitor. Carvedilol suppresses atrial as well as ventricular arrhythmias in these patients.

Abbreviations and acronyms

ACE
angiotensin-converting enzyme
AE
adverse event
AF
atrial fibrillation
CAPRICORN
Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction trial
CI
confidence interval
DIAMOND-MI
Danish Investigations of Arrhythmia and Mortality on Dofetilide-Myocardial Infarction study
HR
hazard ratio
MI
myocardial infarction
SAE
serious adverse event
TRACE
Trandolapril Cardiac Evaluation study

Cited by (0)

The CAPRICORN study was funded by GlaxoSmithKline and Roche Pharmaceuticals.