title: Association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: OBJECTIVE
  This study sought to investigate the association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Limited data are available on the efficacy of beta-blocker therapy for secondary prevention in STEMI patients.
  
  
  METHODS
  Between November 1, 2005 and September 30, 2010, 20,344 patients were enrolled in nationwide, prospective, multicenter registries. Among these, we studied STEMI patients undergoing primary PCI who were discharged alive (n = 8,510). We classified patients into the beta-blocker group (n = 6,873) and no-beta-blocker group (n = 1,637) according to the use of beta-blockers at discharge. Propensity-score matching analysis was also performed in 1,325 patient triplets. The primary outcome was all-cause death.
  
  
  RESULTS
  The median follow-up duration was 367 days (interquartile range: 157 to 440 days). All-cause death occurred in 146 patients (2.1%) of the beta-blocker group versus 59 patients (3.6%) of the no-beta-blocker group (p < 0.001). After 2:1 propensity-score matching, beta-blocker therapy was associated with a lower incidence of all-cause death (2.8% vs. 4.1%, adjusted hazard ratio: 0.46, 95% confidence interval: 0.27 to 0.78, p = 0.004). The association with better outcome of beta-blocker therapy in terms of all-cause death was consistent across various subgroups, including patients with relatively low-risk profiles such as ejection fraction >40% or single-vessel disease.
  
  
  CONCLUSIONS
  Beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI. Our results support the current American College of Cardiology/American Heart Association guidelines, which recommend long-term beta-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile.
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: jyhahn@skku.edu.
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Medicine, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Joo Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Medicine, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Young-Keun
authors.initials: YK
authors.lastname: Ahn
authors.affiliation: Division of Cardiology, Department of Medicine, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Division of Cardiology, Department of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Dong-Joo
authors.initials: DJ
authors.lastname: Choi
authors.affiliation: Department of Medicine, Yeungnam University Hospital, Daegu, South Korea.
authors.forename: Jong Seon
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Medicine, Yeungnam University Hospital, Daegu, South Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Medicine, Kyungpook National University Hospital, Daegu, South Korea.
authors.forename: Hun Sik
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea.
authors.forename: Kyoo-Rok
authors.initials: KR
authors.lastname: Han
authors.affiliation: Department of Medicine, Korea University Medical Center, Seoul, South Korea.
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Rha
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: angioplasty; beta-blocker; myocardial infarction