Is pretreatment with Beta-blockers beneficial in patients with acute coronary syndrome?
OBJECTIVE
The role of beta-blockers in the treatment of hypertension is discussed controversially and the data showing a clear benefit in acute coronary syndromes (ACS) were obtained in the thrombolysis era. The goal of this study was to analyze the role of pretreatment with beta-blockers in patients with ACS.


METHODS
Using data from the Acute Myocardial Infarction in Switzerland (AMIS Plus) registry, we analyzed outcomes of patients with beta-blocker pretreatment in whom they were continued during hospitalization (group A), those without beta-blocker pretreatment but with administration after admission (group B) and those who never received them (group C). Major adverse cardiac events defined as composed endpoint of re-infarction and stroke (during hospitalization) and/or in-hospital death were compared between the groups.


RESULTS
A total of 24,709 patients were included in the study (6,234 in group A, 12,344 in group B, 6,131 in group C). Patients of group B were younger compared to patients of group A and C (62.5, 67.6 and 68.4, respectively). In the multivariate analysis, odds ratio for major adverse cardiac events was 0.59 (CI 0.47-0.74) for group A and 0.66 (CI 0.55-0.83) for group B, while group C was taken as a reference.


CONCLUSIONS
beta-Blocker therapy is beneficial in ACS and they should be started in those who are not pretreated and continued in stable patients who had been on chronic beta-blocker therapy before.
Cuculi
F
F
Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Radovanovic
D
D
Pedrazzini
G
G
Regli
M
M
Urban
P
P
Stauffer
J C
JC
Erne
P
P
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists