- Question
- Does long-term oral carvedilol provide benefit in patients with uncomplicated STEMI, without heart failure or left ventricular dysfunction, treated with primary PCI?
- Design
- Multicenter, open-label, randomized controlled trial with 1:1 allocation conducted at 67 centers in Japan. A total of 801 patients were randomized within 7 days after primary PCI, with a median follow-up of 3.9 years and 96.4% follow-up completed.
- Population
- STEMI patients with successful primary PCI within 24 hours of symptom onset and left ventricular ejection fraction ≥40%. Patients with heart failure, left ventricular dysfunction or ventricular arrhythmia were excluded.
- Intervention
- Long-term oral carvedilol, up-titrated from 3.4±2.1 mg at baseline to 6.3±4.3 mg at 1 year, added to contemporary evidence-based medications.
- Control
- No beta-blocker therapy, with the same background evidence-based medications.
- Primary outcome
- Composite of all-cause death, myocardial infarction, hospitalization for heart failure, and hospitalization for acute coronary syndrome.
- Results
- The cumulative 3-year incidence of the primary endpoint was 6.8% with carvedilol and 7.9% without beta-blocker (P = 0.20), not significantly different. There was also no significant difference in LVEF at 1 year (60.9±8.4% vs 59.6±8.8%; P = 0.06).
- Conclusion
- Long-term carvedilol added to contemporary evidence-based therapy did not appear beneficial in selected STEMI patients treated with primary PCI.
- Why it matters
- It questioned the routine long-term use of beta-blockers in low-risk STEMI patients with preserved ventricular function and successful revascularization, a practice that had not previously been tested in randomized trials in this setting.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 21, 2026