title: Beta-blocker use in ST-segment elevation myocardial infarction in the reperfusion era (GRACE).
abstract: BACKGROUND
  Current guidelines recommend early oral beta-blocker administration in the management of acute coronary syndromes for patients who are not at high risk of complications.
  
  
  METHODS
  Data from patients enrolled between 2000 and 2007 in the Global Registry of Acute Coronary Events (GRACE) were used to evaluate hospital outcomes in 3 cohorts of patients admitted with ST-elevation myocardial infarction, based on beta-blocker use (early [first 24 hours] intravenous (IV) [± oral], only early oral, or delayed [after first 24 hours]).
  
  
  RESULTS
  Among 13,110 patients with ST-elevation myocardial infarction, 21% received any early IV beta-blockers, 65% received only early oral beta-blockers, and 14% received delayed (>24 hours) beta-blockers. Higher systolic blood pressure, higher heart rate, and chronic beta-blocker use were independent predictors of early beta-blocker use. Early beta-blocker use was less likely in older patients, patients with moderate to severe left ventricular dysfunction, and in those presenting with inferior myocardial infarction or Killip class II or III heart failure. IV beta-blocker use and delayed beta-blocker use were associated with higher rates of cardiogenic shock, sustained ventricular fibrillation/ventricular tachycardia, and acute heart failure, compared with oral beta-blocker use. In-hospital mortality was increased with IV beta-blocker use (propensity score adjusted odds ratio, 1.41; 95% confidence interval, 1.03-1.92) but significantly reduced with delayed beta-blocker administration (propensity adjusted odds ratio, 0.44; 95% confidence interval, 0.26-0.74).
  
  
  CONCLUSIONS
  Early beta-blocker use is common in patients presenting with ST-elevation myocardial infarction, with oral administration being the most prevalent. Oral beta-blockers were associated with a decrease in the risk of cardiogenic shock, ventricular arrhythmias, and acute heart failure. However, the early receipt of any form of beta-blockers was associated with an increase in hospital mortality.
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester.
authors.forename: Kay Lee
authors.initials: KL
authors.lastname: Park
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.affiliation: Cardiology Department, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: López-Sendón
authors.affiliation: Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.affiliation: Concord Repatriation General Hospital, Coronary Care Unit, Concord, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.affiliation: University of Michigan Health System, Ann Arbor.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester.
authors.forename: Allison
authors.initials: A
authors.lastname: Wyman
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester. Electronic address: joel.gore@umassmemorial.org.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004334:Drug Administration Schedule; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D057216:Propensity Score; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Clinical outcomes; Intravenous beta-blockers; Oral beta-blockers; ST-elevation myocardial infarction