Am J Cardiol. 2012 Dec 7. pii: S0002-9149(12)02311-9. doi: 10.1016/j.amjcard.2012.10.026. [Epub ahead of print]
Nakatani D,
Sakata Y,
Suna S,
Usami M,
Matsumoto S,
Shimizu M,
Hara M,
Uematsu M,
Fukunami M,
Hamasaki T,
Sato H,
Hori M,
Komuro I;
Osaka Acute Coronary Insufficiency Study (OACIS) Investigators.
Source
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Abstract
Although clinical guidelines recommend long-term β-blocker (BB) therapy to decrease mortality after acute myocardial infarction,
these recommendations are based predominantly on evidence from before
the reperfusion and thrombolytic eras. To investigate the effects of BB therapy for patients with acute myocardial infarctions on mortality in the percutaneous coronary intervention era, a total of 5,628 consecutive patients who were admitted <24 class="highlight" hours="" span="">after
the onset of
ST-segment elevation myocardial infarction, treated with emergent
percutaneous coronary intervention, and discharged alive were studied. During a median follow-up period of 1,430 days,
mortality rates did not differ between patients with and without BB
therapy (5.2% vs 6.2%, p = 0.786). Multivariate analysis revealed that BB treatment was not associated with a reduced risk for
mortality
(hazard ratio 0.935, 95% confidence interval 0.711 to 1.230, p =
0.534). The results of propensity score matching also indicated that the
mortality
rates did not differ between the 2 groups. However, subgroup analyses
among matched populations revealed that BB treatment was associated with
a significantly lower
mortality risk for high-risk patients, who were defined as those with Global Registry of
Acute Coronary
Events (GRACE) risk scores ≥121 (hazard ratio 0.596, 95% confidence
interval 0.416 to 0.854, p = 0.005) or those administered diuretics
(hazard ratio 0.602, 95% confidence interval 0.398 to 0.910, p = 0.016),
but not for lower risk patients. In conclusion, BB treatment was
associated with reduced
long-term mortality in patients
after ST-segment elevation myocardial infarction
at higher risk, but not in those at lower risk. Although randomized
controlled studies are warranted to confirm these results, the
implementation of BB
therapy for discharged patients with
ST-segment elevation myocardial infarction may need to be assessed on the basis of individual
mortality risk in the
percutaneous coronary intervention era.Copyright © 2013 Elsevier Inc. All rights reserved.
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