title: Association of beta-blocker treatment with mortality following myocardial infarction in patients with chronic obstructive pulmonary disease and heart failure or left ventricular dysfunction: a propensity matched-cohort analysis from the High-Risk Myocardial Infarction Database Initiative.
abstract: To determine the influence of baseline beta-blocker use on long-term prognosis of myocardial infarction (MI) survivors complicated with heart failure (HF) or with left ventricular dysfunction and with history of chronic obstructive pulmonary disease (COPD).
  
  
  
  Among the 28 771 patients from the High-Risk MI Database Initiative we identified 1573 patients with a baseline history of COPD. We evaluated the association between beta-blocker use at baseline (822 with beta-blocker and 751 without) on the rates of all-cause and cardiovascular mortality. On univariable Cox analysis, beta-blocker use was found to be associated with lower rates of both all-cause [hazard ratio (HR) = 0.61, 95% confidence interval (CI) 0.51-0.75, P < 0.0001] and cardiovascular mortality (HR = 0.63, 95% CI 0.51-0.78, P < 0.0001). After extensive adjustment for confounding, including 24 baseline covariates, COPD patients still benefited from beta-blocker usage (HR = 0.73, 95% CI 0.60-0.90, P = 0.002 for all-cause mortality; HR = 0.77, 95% CI 0.61-0.97, P = 0.025 for cardiovascular mortality). Adjusting for propensity scores (PS) constructed from the 24 aforementioned baseline characteristics provided similar results. In a cohort of 561 pairs of patients taking or not taking beta-blocker matched on PS using a 1:1 nearest-neighbour matching method, patients treated with beta-blocker experienced fewer all-cause deaths (HR = 0.71, 95% CI 0.56-0.89, P = 0.003) and cardiovascular deaths (HR = 0.76, 95% CI 0.59-0.97, P = 0.032).
  
  
  
  In the specific setting of a well-treated cohort of high-risk MI survivors, beta-blockers were associated with better outcomes in patients with COPD.
authors: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.|Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
authors: Stefano
authors: S
authors: Coiro
authors: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
authors: Nicolas
authors: N
authors: Girerd
authors: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
authors: Patrick
authors: P
authors: Rossignol
authors: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.|Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
authors: João Pedro
authors: JP
authors: Ferreira
authors: ANMCO Research Centre, Firenze, Italy.
authors: Aldo
authors: A
authors: Maggioni
authors: Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI, USA.
authors: Bertram
authors: B
authors: Pitt
authors: Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
authors: Isabella
authors: I
authors: Tritto
authors: Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
authors: Giuseppe
authors: G
authors: Ambrosio
authors: University of Bergen, Stavanger University Hospital, Stavanger, Norway.
authors: Kenneth
authors: K
authors: Dickstein
authors: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.|INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
authors: Faiez
authors: F
authors: Zannad
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D065840:Protective Factors; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy*
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Beta-blockers; Chronic obstructive pulmonary disease; Mortality; Myocardial infarction