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IMPACT OF BETA-BLOCKER THERAPY AT DISCHARGE ON CLINICAL OUTCOMES IN PATIENTS WITH STEMI UNDERGOING PRIMARY PCI
E60 JACC March 12, 2013 Volume 61, Issue 10
Acute Coronary Syndromes Impact of Beta-Blocker Therapy at Discharge on Clinical Outcomes in Patients with STEMI Undergoing Primary PCI Poster Contributions Poster Sessions, Expo North Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: ACS Therapy: Key Observational Data Abstract Category: 3. Acute Coronary Syndromes: Therapy Presentation Number: 1168-182 Authors: Young Bin Song, Jeong Hoon Yang, Joo-Yong Hahn, Ki Hong Choi, Seung-Hyuk Choi, Jin-Ho Choi, Sang Hoon Lee, Myung-Ho Jeong, Dong-Joo Choi, Young-Jo Kim, Hyeon-Cheol Gwon, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea Background: Limited data are available on the efficacy of β-blocker therapy for secondary prevention in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: Between November 2005 and September 2010, 20344 patients were enrolled in a nationwide, prospective, multi-center registry series for MI in Korea. Among these, we studied STEMI patients undergoing primary PCI who were discharged alive (n=8510). We classified patients into the β-blocker group (n=6873) and no-β-blocker group (n=1637) according to the use of β-blockers at discharge. Propensity-score matching analysis was also performed in 1371 patient pairs (2742 patients from the β-blocker group and 1371 patients from the no-β-blocker group). The primary outcome was all-cause death. Results: The median follow-up duration was 342 (interquartile range: 58 to 393) days. All-cause death occurred in 115 patients (1.7%) of the β-blocker group versus 49 patients (3.0%) of the no-β-blocker group (P < 0.001). After 2:1 propensity-score matching, β-blocker therapy was associated with a lower incidence of all-cause death (2.3% vs. 3.2%, adjusted hazard ratio 0.46, 95% confidence interval 0.25-0.84, P = 0.01). The benefit of β-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 ACC/AHA guidelines which recommend long-term β-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile.
Acute Coronary Syndromes Impact of Beta-Blocker Therapy at Discharge on Clinical Outcomes in Patients with STEMI Undergoing Primary PCI Poster Contributions Poster Sessions, Expo North Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: ACS Therapy: Key Observational Data Abstract Category: 3. Acute Coronary Syndromes: Therapy Presentation Number: 1168-182 Authors: Young Bin Song, Jeong Hoon Yang, Joo-Yong Hahn, Ki Hong Choi, Seung-Hyuk Choi, Jin-Ho Choi, Sang Hoon Lee, Myung-Ho Jeong, Dong-Joo Choi, Young-Jo Kim, Hyeon-Cheol Gwon, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea Background: Limited data are available on the efficacy of β-blocker therapy for secondary prevention in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: Between November 2005 and September 2010, 20344 patients were enrolled in a nationwide, prospective, multi-center registry series for MI in Korea. Among these, we studied STEMI patients undergoing primary PCI who were discharged alive (n=8510). We classified patients into the β-blocker group (n=6873) and no-β-blocker group (n=1637) according to the use of β-blockers at discharge. Propensity-score matching analysis was also performed in 1371 patient pairs (2742 patients from the β-blocker group and 1371 patients from the no-β-blocker group). The primary outcome was all-cause death. Results: The median follow-up duration was 342 (interquartile range: 58 to 393) days. All-cause death occurred in 115 patients (1.7%) of the β-blocker group versus 49 patients (3.0%) of the no-β-blocker group (P < 0.001). After 2:1 propensity-score matching, β-blocker therapy was associated with a lower incidence of all-cause death (2.3% vs. 3.2%, adjusted hazard ratio 0.46, 95% confidence interval 0.25-0.84, P = 0.01). The benefit of β-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 ACC/AHA guidelines which recommend long-term β-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile.