Carvedilol Post Infarct Survival Control in Left Ventricular Dysfunction Study

Associate Editor-In-Chief:

CAPRICORN = Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction Study

Overview
A multicenter, multinational, double-blind, randomized, placebo-controlled trial that enrolled 1,959 patients who had an acute MI and a left ventricular ejection fraction of <40%.

It was not known whether beta blockers confer additional benefit when used in the context of modern post-MI management (eg, fibrinolytic therapy and primary percutaneous transluminal coronary angioplasty, aspirin, and angiotensin converting enzyme inhibitors).

Patients in CAPRICORN were treated with a maximum dose of 25 mg bid and observed until 633 validated primary end points had occurred. Because the overall mortality was lower than had been predicted, a co-primary end point was adopted that included the original primary end point (all-cause mortality) plus the first of the prespecified secondary end points (all-cause mortality or cardiovascular hospitalizations).

A significant 23% reduction in the original primary end point of all-cause mortality was observed. A total of 340 (35%) patients died or had a cardiovascular hospitalization in the carvedilol group versus 367 (37%) in the placebo group. Therefore, the revised primary end point of all-cause mortality or cardiovascular hospitalization was reduced by 8%, which was not statistically significant.

Significant reductions in cardiovascular mortality, nonfatal MI, and the combination of all-cause mortality or nonfatal MI were observed.

Although statistical significance for the revised primary end point was not reached, CAPRICORN has an important role in guiding future use of beta blockers in the early post-MI period.