Cardiovascular Diseases Clinical Trial
To determine whether the regular administration of the beta-blocker drug propranolol to people who had had at least one documented myocardial infarction would result in a significant reduction of mortality from all causes over the follow-up period. Eligible volunteer patients were recruited to participate in a double-blind clinical trial within 21 days after the onset of the acute event. One-half of the patients were randomly assigned to a beta-blocking drug (propranolol) and one-half to a placebo. The trial also evaluated the effect of propranolol on incidences of coronary heart disease mortality, sudden cardiac death, and nonfatal myocardial infarction plus coronary heart disease mortality in persons with documented previous myocardial infarction.
BACKGROUND:
Survivors of a documented myocardial infarction are recognized as having a high risk of
dying relative to the general population. Serious arrhythmias, occurring with or without
evidence of new infarction, are a common cause of death in this population. Theoretically,
an agent which (1) can block the sympathetic nervous activity thought to be involved in
precipitating sudden death and (2) has non-neurogenic antiarrhythmic properties would be of
value to people with coronary heart disease. Propranolol, like other beta- blocking agents,
has these as well as other properties and therefore might be expected to prevent or retard
complications of coronary heart disease such as serious arrhythmias. This would be reflected
in a decrease in mortality due to coronary heart disease.
A workshop on chronic antiarrhythmic therapy reviewed contemporary experimental data and
clinical practice and recommended that a clinical trial be undertaken to clearly show the
effects of beta-blocking drugs on mortality. Subsequently, such a trial was approved by the
Clinical Applications and Prevention Advisory Committee, by the Cardiology Advisory
Committee, and by the National Heart, Lung, and Blood Advisory Council.
The study protocol was reviewed in February 1978 and recommended for approval by the
policy-data monitoring board and ad hoc members. The protocol was approved by the Director
of NHLBI in March 1978. Recruitment started on June 19, 1978, and ended in October 1980. A
total of 3,837 patients were randomized. Units which participated in the trial included 32
clinical centers, an EKG center, a central laboratory, a coordinating center, a 1-hour
ambulatory ECG center, a 24-hour ambulatory EKG center, and an EKG tape quality control
center.
DESIGN NARRATIVE:
A randomized, double-blind design with single experimental and control groups. Patients were
recruited while in the hospital for an acute myocardial infarction and were enrolled in the
study before discharge. Eligible patients fulfilled the study definition of an acute
myocardial infarction. The diagnosis was based either on electrocardiographic records
showing evolving QRS segment changes or on ST segment and T wave changes together with
enzyme changes and appropriate clinical history. One-half of the patients were placed on
therapy using a beta-blocking drug (propranolol). The other half received a placebo. The
prescribed maintenance dosage of propranolol was either l80 or 240 mgs/day, depending upon
serum drug levels. Intervention duration averaged 25 months.
The study completion date listed in this record was obtained from the "Completed Date"
entered in the Query View Report System (QVR).
;
Allocation: Randomized, Masking: Double-Blind, Primary Purpose: Prevention
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