The CAPRICORN Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001;357:1385-90.
Bottom-line: In patients with LV dysfunction post-MI, carvedilol reduces the risk of death, MI & ventricular arrhythmias (NNT 34 for each) at ~1 year.
Patients (n=1959)
- Included
- Age 18+ y
- 3-21 days post-MI
- LVEF 40% or less
- Receiving ACEI >48h with stable dose >24h (or intolerance to ACEI)
- Excluded
- Uncontrolled HF or HF requiring IV diuretics or inotropes
- Unstable angina
- SBP <90 mm Hg or uncontrolled HTN
- HR <60 bpm
- Typical study patient
- Age 63 y
- Female 27%
- Site: Anterior (57%), inferior (21%)
- PMHx
- Prior MI 31%, angina 57%
- Smoker 33%
- HTN 55%
- Diabetes 21%
- BP 121/74 mm Hg
- HR 77 bpm
- LVEF 33%
- Meds
Interventions
- I: Carvedilol
- Initial dose of 6.25 mg PO BID, doubled or halved to max target dose of 25 mg PO BID
- Conditions for uptitration, done q3-10 days:
- Absence of clinical HF or adverse events
- SBP >80 mm Hg & HR >50 bpm
- 74% achieved target dose
- C: Matching placebo
Results @ mean 1.3 years
- Death: Carvedilol 12%, placebo 15% (hazard ratio 0.77, 0.60-0.98), NNT 34
- Death or CV hospitalization: 35% vs 37% (HR 0.92, 0.80-1.07)
- HF hospitalization: 12% vs 14% (HT 0.86, 0.67-1.09)
- Non-fatal MI: 3% vs 6% (HR 0.59, 0.39-0.90), NNT 34%
- Ventricular arrhythmia (tach/flutter/fib): 0.9% vs 3.9% (HR 0.24, 0.11-0.49), NNT 34
