CAPRICORN trial

STEMI (17). This landmark trial revealed that the use of early beta-blocker therapy in STEMI reduces the risks of reinfarction and ventricular fibrillation. However, there was a small increase in frequency of cardiogenic shock in patients randomized to the beta-blocker group. Therefore, beta-blockers should be contraindicated in patients presenting with a cardiogenic shock or decompensated congestive heart failure (CHF). Other relative contraindications to beta-blockers include advanced heart block, bradyarrythmias, and active asthma. Unless these contraindications are present, the (ACC/AHA) guidelines list oral beta-blocker therapy within 24 hours as a class I indication in patients with ACS (18). In patients presenting with left ventricular dysfunction after MI as defined by an ejection fraction <40%, carvedilol has been shown to reduce reinfarction rate and mortality in the Carvedilol Post Infarction Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial when compared with placebo (19). 

McMurray, J., et al., Antiarrhythmic effect of carvedilol after acute myocardial infarction results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) Trial. J Am Coll Cardiol, 2005. 45(4) p. 525-30. 

Abbreviations-. BEST, beta-blocker evaluation survival trial CAPRICORN, caiveclilol postinfarct suivival control in left ventricular dysfunction C1B1S II, Cardiac Insufficiency Bisoprolol Study II COMET, Carvedilol or Metoprolol European Trial COPERNICUS, carvedilol prospective randomized cumulative survival HF, heart failure LVEF, left ventricular ejection fraction MDC, metoprolol in dilated cardiomyopathy MERIT-HF, metoprolol controlled-release randomized intervention trial in congestive heart failure fJYHA, New York Heart Association. 

Dargie HJ, Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction the CAPRICORN randomised trial. Lancet 2001 357 1385-1390. 

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