β-Blocker therapy and cardiovascular outcomes in patients who have undergone percutaneous coronary intervention after ST-elevation myocardial infarction.
The effect of β-blockers in ST-elevation myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (PCI) has not been adequately evaluated. Using a large multi-center registry in Japan, we identified 3,692 patients who underwent PCI within 24 h from onset of STEMI and were discharged alive from 2005 to 2007. Three-year cardiovascular outcomes were compared between the 2 groups of patients with (N = 1,614) or without (N = 2,078) β-blocker prescription at discharge. Compared with patients in the no-β group, patients in the β group were younger, more frequently male, more often had hypertension and atrial fibrillation but less often had chronic obstructive pulmonary disease than in the no-β group. Statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers were more frequently prescribed in the β group. Crude incidence of cardiac death and/or recurrent myocardial infarction (cardiac death/MI) tended to be higher in the β group (7.6 vs. 6.2%, log-rank p = 0.1). After adjusting for potential confounders, β-blockers were associated with significantly higher risk for cardiac death/MI (hazard ratio 1.43, 95% CI: 1.06-1.94, p = 0.01). β-Blocker prescription at discharge was not associated with better cardiovascular outcomes in patients who underwent PCI after STEMI. Large-scale randomized controlled trials are needed to evaluate the role of β-blocker therapy in these patients.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Bingyuan
B
Bao
Neiko
N
Ozasa
Takeshi
T
Morimoto
Yutaka
Y
Furukawa
Yoshihisa
Y
Nakagawa
Kazushige
K
Kadota
Masashi
M
Iwabuchi
Satoshi
S
Shizuta
Hiroki
H
Shiomi
Tomohisa
T
Tada
Junichi
J
Tazaki
Yoshihiro
Y
Kato
Mamoru
M
Hayano
Masahiro
M
Natsuaki
Hisayoshi
H
Fujiwara
Kazuaki
K
Mitsudo
Masakiyo
M
Nobuyoshi
Toru
T
Kita
Takeshi
T
Kimura
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D003131:Combined Modality Therapy; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention; D011412:Propanolamines / Q000627:therapeutic use*; D057216:Propensity Score; D012042:Registries; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol