Therapeutic efficacy of combined esmolol and carvedilol treatment for myocardial ischemia in patients with coronary heart disease.

OBJECTIVE

To evaluate the effects of esmolol plus carvedilol in treating myocardial ischemia in coronary heart disease (CHD), with a focus on blood pressure (BP), heart rate (HR), and safety.

METHODS

A total of 120 patients with CHD-related myocardial ischemia admitted to our hospital between January 2022 and January 2023 were enrolled. Among them, 60 patients were treated with carvedilol monotherapy (control group), and the other 60 cases received esmolol in combination with carvedilol (research group). Therapeutic efficacy, BP, HR, premature beat counts, dynamic electrocardiogram parameters (duration and frequency of ST-segment depression), cardiac function indicators (left ventricular end-diastolic dimension [LVEDD], left ventricular posterior wall thickness [LVPWT], left ventricular septal thickness [LVST], left ventricular ejection fraction [LVEF]), and biochemical indicators (N-terminal pro-B-type natriuretic peptide [NT-proBNP], superoxide dismutase [SOD]) were assessed. Safety profiles, including nausea and vomiting, hypotension, and drowsiness, were recorded. Furthermore, factors influencing therapeutic efficacy were analyzed.

RESULTS

Compared with the control group, patients in the research group exhibited significantly lower BP (systolic: (105.27±7.72) mmHg vs. (113.78±11.46) mmHg; diastolic: (64.98±4.81) mmHg vs. (71.35±7.76) mmHg and HR (67.90±5.63) bpm vs. (85.67±7.35) bpm). In addition, post-treatment premature beat counts (premature ventricular contraction count: (71.15±26.02) times/24 h vs. (253.67±78.62) times/24 h; premature atrial contraction count: (105.35±41.38) times/24 h vs. (279.53±59.30) times/24 h; junctional premature contraction count: (73.85±30.65) times/24 h vs. (153.58±40.07) times/24 h) were notably reduced in the research group. The duration ((22.90±3.43) min vs. (54.50±4.34) min) and frequency ((7.25±1.97) times vs. (12.47±3.33) times), of ST-segment depression were significantly decreased in the research group. Moreover, LVEDD ((42.05±4.21) mm vs. (46.48±3.98) mm), LVPWT ((9.23±2.25) mm vs. (11.18±2.59) mm), LVST ((8.72±2.48) mm vs. (10.30±2.71) mm), and NT-proBNP ((310.63±32.83) pg/mL vs. (403.87±40.51) pg/mL) were significantly reduced in the research group, whereas LVEF ((59.63±6.77)% vs. (53.73±5.04)%) and SOD ((112.72±10.12) U/mL vs. (90.60±9.85) U/mL) were significantly increased. The overall incidence of adverse events was lower in the research group. Multivariate analysis identified HR (OR=4.592, 95% CI: 1.289-16.366, P=0.019), LVEF (OR=0.290, 95% CI: 0.086-0.976, P=0.046), and NT-proBNP (OR=3.729, 95% CI: 1.124-12.371, P=0.031) as independent factors influencing therapeutic efficacy.

CONCLUSIONS

Esmolol combined with carvedilol demonstrates superior efficacy and safety compared with carvedilol monotherapy in patients with myocardial ischemia secondary to CHD.