BHAT: Beta-blocker Heart Attack Trial
Purpose
To determine whether the β-blocker propranolol reduces all-cause mortality in patients with acute MI
Reference
β-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 1982; 247: 1707–14.
BHAT: Beta-blocker Heart Attack Trial - TRIAL DESIGN -
Design
Multicenter, randomized, double-blind, placebo-controlled
Patients
3837 patients, aged 30–69 years, hospitalized with acute MI 5–21 days previously; patients with history of severe congestive heart failure excluded
Follow up and primary end point
Mean 25 months follow up. Primary endpoint all-cause mortality
Treatment
Placebo or propranolol, 60 or 80 mg three times daily
BHAT: Beta-blocker Heart Attack Trial - RESULTS -
Study halted early because all-cause mortality significantly less in propranolol group than placebo group (7.2 vs. 9.8%, 2P<0.005)
Also significant reduction in:
Cardiovascular death
Sudden death from arteriosclerotic heart disease
Subgroups exhibited same trend of reduction in all-cause mortality with propranolol compared with placebo, with exception of patients with nontransmural infarct
Although permanent early treatment withdrawal due to hypotension, gastrointestinal problems and serious ventricular arrhythmia was significantly more frequent in the propranolol group, serious side effects were uncommon
BHAT: Beta-blocker Heart Attack Trial - RESULTS continued -
Months after randomization
0
0
3837
No. of patients
followed up
3706
3647
2959
2163
1310
406
6
12
18
24
30
36
4
2
12
14
10
8
6
All-cause mortality
Placebo
Propranolol
Cumulative
mortality
(%)
BHAT Research Group. JAMA 1982; 247: 1707–14.
BHAT: Beta-blocker Heart Attack Trial - RESULTS continued -
P
(two-sided)
Total mortality
Cardiovascular disease
Arteriosclerotic heart disease
Sudden
Nonsudden
Other cardiovascular disease
Noncardiovascular disease
9.8
8.9
8.5
4.6
3.9
0.4
0.9
7.2
6.6
6.2
3.3
2.9
0.4
0.6
<0.005
<0.01
<0.01
<0.05
NS
NS
NS
All-cause mortality and specific causes of mortality at 25-month follow up
Placebo
n=1921
(%)
Propranolol
n=1916
(%)
BHAT Research Group. JAMA 1982; 247: 1707–14.
BHAT: Beta-blocker Heart Attack Trial - RESULTS continued -
Anterior
Anterior and inferior
Inferior
Nontransmural
Infarct location:
0.67
0.75
0.61
1.07
7.5
11.4
5.1
8.2
533
176
605
438
Effect of propranolol on subgroups
Subgroup
Mortality
(%)
Life table
relative
risk
Propranolol
BHAT Research Group. JAMA 1982; 247: 1707–14.
10.9
15.1
8.2
7.8
494
192
623
435
Mortality
(%)
Placebo
No. of
patients in
subgroup
No. of
patients in
subgroup
BHAT: Beta-blocker Heart Attack Trial - RESULTS continued -
P
(two-sided)
Congestive heart failure
Hypotension
Sinus bradycardia
Serious ventricular arrhythmia
Tiredness
Faintness
Nightmares
Gastrointestinal problems
3.5
0.3
0.3
1.0
1.0
0.2
0.2
0.3
4.0
1.2
0.7
0.3
1.5
0.5
0.1
1.0
NS
<0.005
NS
<0.025
NS
NS
NS
<0.01
Reasons for withdrawal of propranolol or placebo
Placebo
n=1921
(%)
Propranolol
n=1916
(%)
BHAT Research Group. JAMA 1982; 247: 1707–14.
BHAT: Beta-blocker Heart Attack Trial - SUMMARY -
In patients with acute MI, propranolol reduced:
All-cause mortality
Cardiovascular death and sudden death from arteriosclerotic heart disease
Benefit was independent of age, sex or infarct location (except nontransmural infarct)