Effect of early bisoprolol administration on ventricular arrhythmia and cardiac death in patients with non-ST elevation myocardial infarction.
OBJECTIVE
To investigate the impact of early oral beta blockade in patients presenting with acute non-ST elevation myocardial infarction (NSTEMI).


METHODS
We retrospectively identified 890 consecutive patients presenting with NSTEMI to a single UK centre from 2012 to 2014. Included patients all received standardised antiplatelet therapy plus low-dose oral bisoprolol (1.25-2.5 mg) within 4 h (mean 2.2±1.36; 'Early Group') or within 5-24 h (mean 15.4±5.7; 'Late Group') of presentation. Patients were followed up for the duration of hospital stay with the incidence of major adverse cardiovascular events (MACE-defined as ventricular arrhythmia, cardiac death or repeat infarction) set as the primary outcome. Multivariate logistic regression models analysed early versus late bisoprolol administration and adjusted for potential confounders.


RESULTS
399 patients were included. Of the patient parameters, only the GRACE score was significantly different between the early (n=99, GRACE 164.5±29.6) and late (n=300, GRACE 156.7±31.4) groups (p=0.033). The early group had significantly fewer ventricular arrhythmias (1 vs 20, p=0.034), cardiac deaths (0 vs 13, p=0.044) and consequently MACE (1 vs 27, p=0.005) than the late group. After adjusting for the confounders of pulse, blood pressure, smoking and creatinine, logistic regression analysis identified early bisoprolol administration as protective for ventricular arrhythmia (p=0.038, OR 0.114, CI 0.015 to 0.885) and MACE (p=0.011, OR 0.064, CI 0.008 to 0.527). There was one episode of symptomatic bradycardia in the late group.


CONCLUSIONS
This study suggests that low-dose oral bisoprolol administered to patients with NSTEMI within 4 h of admission may be protective and lead to reduced inpatient MACE.
Department of Emergency Medicine , Medway Maritime Hospital , Gillingham, Kent , UK.
Edd
E
Maclean
Department of Cardiovascular Medicine , King's College Hospital , London , UK.
Sean
S
Zheng
Department of Cardiovascular Medicine , King's College Hospital , London , UK.
Adam
A
Nabeebaccus
Department of Cardiovascular Medicine , King's College Hospital , London , UK.
Kevin
K
O'Gallagher
Department of Cardiovascular Medicine , Medway Maritime Hospital , Gillingham, Kent , UK.
Adrian
A
Stewart
Department of Cardiovascular Medicine , King's College Hospital , London , UK.
Ian
I
Webb