Problem Suspected acute MI
Format Open-label multi-center RCT
Treatment Atenolol (IV, then oral)
Control Non-beta blocked
Population 16,027 patients
Inclusion criteria Suspected MI thought to be within 12 hours of the onset of symptoms
Exclusion criteria Already on verapamil or beta-blockers
Bradycardia, heart block
Follow-up Mean 20 months
Primary endpoint Combined end-point of death, arrest, or reinfarction
Secondary endpoint(s) -
Details -
Brief summary: Atenolol given within first 24 hours improved mortality (controversial, unblinded, see COMMITT trial)
PAPER: Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group.
Date 12 Jul 1986
Journal Lancet. 1986 Jul 12;2(8498):57-66.
Information -Significant reduction in vascular mortality in treatment week and at 1 year
--Benefit largely in first 24hrs
--Treatment group more likely to be discharged on beta-blockers (?confounding)
--Increased inotrope use

N.B. Not blinded - controversial results; see COMMITT trial.
PAPER: Mechanisms for the early mortality reduction produced by beta-blockade started early in acute myocardial infarction: ISIS-1. ISIS-1 (First International Study of Infarct Survival) Collaborative Group.
Date 23 Apr 1988
Journal Lancet 1988 Jul 30;2(8605):292.
Information Case notes obtained from early deaths (193 of 217 available)
-Indicates mortality benefits likely due to reduced electromechanical dissociation (likely from acute rupture)