title: Intravenous beta-blocker therapy in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention is not associated with benefit regarding short-term mortality: a Swedish nationwide observational study.
abstract: OBJECTIVE
  Our aim was to investigate the impact of intravenous (IV) beta-blocker therapy on short-term mortality and other in-hospital events in patients with ST-segment elevation myocardial infarction (STEMI) treated with dual antiplatelet therapy (DAPT) and primary percutaneous coronary intervention (PCI).
  
  
  RESULTS
  Using the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we identified all patients with STEMI undergoing PCI between 2006 and 2013. Patients with cardiogenic shock and cardiac arrest at presentation were excluded. The primary endpoint was mortality within 30 days. Secondary endpoints were in-hospital events (mortality, cardiogenic shock and left ventricular ejection fraction [LVEF] <40% at discharge). We adjusted for confounders with a multivariable model and propensity score matching. Out of 16,909 patients, 2,876 (17.0%) were treated with an IV beta-blocker. After adjusting for confounders, the IV beta-blocker group had higher 30-day all-cause mortality (HR: 1.44, 95% CI: 1.14-1.83), more in-hospital cardiogenic shock (OR: 1.53, 95% CI: 1.09-2.16) and were more often discharged with an LVEF <40% (OR: 1.70, 95% CI: 1.51-1.92).
  
  
  CONCLUSIONS
  In this large nationwide observational study, the use of IV beta-blockers in patients with STEMI treated with primary PCI was associated with higher short-term mortality, lower LVEF at discharge, as well as a higher risk of in-hospital cardiogenic shock.
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
authors.forename: Moman A
authors.initials: MA
authors.lastname: Mohammad
authors.forename: Pontus
authors.initials: P
authors.lastname: Andell
authors.forename: Sasha
authors.initials: S
authors.lastname: Koul
authors.forename: Liyew
authors.initials: L
authors.lastname: Desta
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.forename: Elmir
authors.initials: E
authors.lastname: Omerovic
authors.forename: Jonas
authors.initials: J
authors.lastname: Spaak
authors.forename: Ole
authors.initials: O
authors.lastname: Fröbert
authors.forename: Jens
authors.initials: J
authors.lastname: Jensen
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.forename: Claes
authors.initials: C
authors.lastname: Hofman-Bang
authors.forename: Hans
authors.initials: H
authors.lastname: Persson
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
mesh_terms: D061605:Administration, Intravenous; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D057216:Propensity Score; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality; D013318:Stroke Volume / Q000187:drug effects; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D010975:Platelet Aggregation Inhibitors