Abstract: 1071-113

Effect of Carvedilol on Major Cardiovascular Events in Post-Infarction Patients Treated With Angiotensin Converting Enzyme Inhibitors: Further Analysis of the Capricorn Trial

Jonathan Sackner-Bernstein, Ian Ford, Michele Robertson, Mary Ann Lukas, Milton Packer, Henry Dargie

St. Luke's-Roosevelt Hospital Center, New York, NY

Topic: Acute Myocardial Infarction--Therapy

Background: The CAPRICORN trial evaluated the effect of carvedilol (CRV) on the risk of death and the combined risk of death or cardiovascular hospitalization (CVH) in post-myocardial infarction (MI) patients with left ventricular dysfunction receiving an ACE inhibitor. CRV reduced the risk of death by 23% (p=0.03) but reduced the risk of death or CVH by only 9% (p=0.30).

Methods: To explore the reasons for these findings, we analyzed the results of the CAPRICORN trial using endpoints that had been used to show the efficacy of beta-blockers in other trials (post-MI beta-blocker trials and the COPERNICUS trial). In the COPERNICUS trial, the protocol-specified analysis of CVH focused on major CVH (those for heart failure, MI or unstable angina, stroke or TIA, supraventricular or ventricular arrhythmia, bradycardia or heart block), whereas the prespecified definition in the CAPRICORN trial included all CVH (major or minor) except for procedures.

Results: CRV reduced the risk of a major event when endpoints were analyzed that had been shown in earlier studies to be favorably influenced by beta-blockade. This included a 17% reduction in the risk of death or major CVH (defined as in the COPERNICUS trial)(p=0.02), and significant reductions in the risk of fatal or non-fatal MI.

Conclusions: These findings provide additional support for the efficacy of CRV in post-MI patients already treated with an ACE inhibitor.