Nonthrombolytic intervention in acute myocardial infarction.

Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115.

The American journal of cardiology 1989 Jul 18

Alternative interventions are available for patients in whom thrombolytic therapy is inappropriate after an acute myocardial infarction. Administration of a beta blocker within the first 24 hours of the patient's admission to the coronary care unit can reduce overall morbidity and mortality within the first 7 days by about 15%. Maintenance therapy with an oral beta blocker can reduce mortality within the succeeding 3 years by about 25%. Esmolol, a unique cardioselective beta 1-adrenergic receptor blocker with a half-life of 9 minutes, can enable some patients with relative contraindications to beta blockers to nevertheless benefit from early beta-blocking therapy. It also is useful in screening patients for subsequent therapy with beta blockers. Those who tolerate the esmolol infusion can be given a long-acting beta blocker. For patients who exhibit intolerance to esmolol, the infusion can be terminated with rapid return to baseline hemodynamics.