title: Impact of pre-procedural beta blockade on inpatient mortality in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction.
abstract: Early use of β blockers (BBs) in acute myocardial infarction remains controversial, with some studies demonstrating benefit and others harm. The aim of this study was to assess the association between pre-percutaneous coronary intervention (PCI) BB use and in-hospital outcomes in patients who underwent primary PCI for ST-segment elevation myocardial infarction between 2007 and 2009 at institutions participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC-2). Inverse propensity score weighting was used to account for the nonrandomized use of pre-PCI BBs. The cohort comprised 7,667 patients, with 4,769 (62%) receiving pre-PCI BBs. These patients were older, with higher rates of diabetes mellitus, hypertension, and previous myocardial infarction, PCI, or coronary artery bypass grafting. In adjusted models, pre-PCI BB use was associated with lower rates of intraprocedural ventricular tachycardia or ventricular fibrillation (odds ratio [OR] 0.58, p <0.01) and lower in-hospital mortality (OR 0.65, p = 0.022), with increases in rates of emergent coronary artery bypass grafting (OR 1.56, p <0.01) and repeat PCI (OR 1.93, p <0.01). There were no significant increases in rates of cardiogenic shock and congestive heart failure. In conclusion, pre-PCI BB use in this population was associated with decreased arrhythmia and mortality, without increasing rates of cardiogenic shock and heart failure but with higher rates of repeat PCI and emergent coronary artery bypass grafting, suggesting that there may yet remain a role for early BB use in pre-PCI patients with ST-segment elevation myocardial infarctions.
authors.affiliation: Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Javier A
authors.initials: JA
authors.lastname: Valle
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.forename: David
authors.initials: D
authors.lastname: Share
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Naoum
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D018674:Adrenergic Antagonists / Q000627:therapeutic use*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D011300:Preoperative Care; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018674:Adrenergic Antagonists