Beta-blocker in post-myocardial infarct survivors with preserved left ventricular systolic function.
BACKGROUND
Long-term beta-blockade therapy is beneficial in post-myocardial infarct (MI) patients with left ventricular (LV) dysfunction; nevertheless, its benefit in post-MI patients with preserved LV function remains unclear. The objective of this study is to investigate the effects of long-term beta-blockade therapy on the clinical outcomes in post-MI patients with preserved LV function.


OBJECTIVE
The beneficial effects of long-term beta-blockade therapy in post-MI patients with impaired LV function may extend to those with preserved LV function.


METHODS
Of 617 consecutive post-MI patients referred for cardiac rehabilitation program, 208 patients (age: 62.7 +/- 0.8 years; male: 76%) with preserved LV function (ejection fraction >or= 50%), negative exercise stress test, and on angiotensin-converting enzyme inhibition were studied.


RESULTS
Baseline characteristics were comparable between patients on beta-blocker (n = 154) and not on beta-blocker (n = 54). After a mean follow-up of 58.5 +/- 2.7 months, 14 patients not on beta-blocker (26%) and 14 patients on beta-blocker (9%) died with hazard ratio (HR) of 2.5 (95% confidence interval [CI]: 1.25-6.42, P = 0.01). Likewise, patients not on beta-blocker had a higher incidence of cardiac death (HR: 3.0, 95% CI: 1.07-12.10, P = 0.04), and non-sudden cardiac death (HR: 10.1, 95% CI: 1.82-89.65, P = 0.01), but not sudden cardiac death compared with patients on beta-blocker (HR: 1.6, 95% CI: 0.34-7.61, P = 0.54). A Cox regression analysis revealed that only advanced age (>or=75 years; HR: 2.55, 95% CI: 1.18-5.49, P = 0.02) and the absence of beta-blocker (HR: 2.41, 95% CI: 1.14-5.09, P = 0.02) were independent predictors for mortality.


CONCLUSIONS
beta-blocker use was associated with a decrease in overall mortality and cardiac death in post-MI patients with preserved LV function.
Siu
Chung-Wah
CW
Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Pong
Vincent
V
Jim
Man-Hong
MH
Yue
Wen-Sheng
WS
Ho
Hee-Hwa
HH
Li
Sheung-Wai
SW
Lau
Chu-Pak
CP
Tse
Hung-Fat
HF
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000534:rehabilitation; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors