Beta-blocker therapy in the era of primary percutaneous intervention for ST elevation myocardial infarction

BACKGROUND: The potential benefit of beta-blocker for ST-elevation myocardial infarction (STEMI) was believed as therapeutic effects of left ventricular (LV) dysfunction. With present therapeutic advance, numbers of STEMI patients with LV dysfunction have been decreased. We studied the long term clinical outcomes of betablocker therapy after successful primary percutaneous coronary intervention (PCI) on STEMI. METHODS: We analyzed the data and clinical outcomes of 901 STEMI patients who underwent primary PCI . We classified patients into beta-blocker (N=598) and non betablocker groups (N=303) according to its use at discharge. Mean follow up month was 54±30 months. Primary end point was all-cause death and secondary end point was major adverse cardiac event (MACE; all-cause death, recurrent MI, target vessel revascularization). RESULTS: The beta-blocker group had lower Killip class, higher ejection fraction, younger ages, more male gender, statin use, hypertension, obesity, use of drug eluting stent and left anterior descending artery infarct. Cumulative incidence of all-cause death was 10.0% (60 patients) in beta-blocker group during mean follow up months of 56±28 and 25.4% (77 patients) in non beta-blocker group during mean follow up months of 49±32 (p<0.001) (Table 3). Incidence of MACE was 22.1% (132 patients) in betablocker group and 34.3% (104 patients) in non beta-blocker group (p<0.001). The relative hazard ratios (HR) for all-cause death and MACE, in beta-blocker group with abnormal LVEF (left ventricle ejection fraction, EF<50%), were 0.54 (95% confidence interval (CI) 0.34-0.85, P=0.008) and 0.72 (95% CI 0.50-1.04, P=0.082). In beta-blocker group with normal LVEF (EF≥50%), the relative HR for death and MACE were 0.50 (95% CI 0.29-0.86, P=0.012) and 0.80 (95% CI 0.54-1.19, P=0.275). After propensity score matching to adjust difference of baseline characteristics, Kaplan-Meier survival curve of beta-blocker group in abnormal LVEF and normal LVEF demonstrated significant lower mortality (P=0.02, P=0.001, respectively). CONCLUSIONS: Beta-blocker has benefit on clinical outcomes in patients with STEMI after primary PCI regardless of LVEF.

Author dc:creator

• 이, 유홍

Contributors dc:contributor

• 탁, 승제
• 대학원 의학과
• 105194

• beta-blocker
• ST-elevation myocardial infarction (STEMI)
• primary percutaneous coronary intervention (PCI)
• left ventricular ejection fraction (LVEF)
• 베타 차단제
• ST 분절 상승 심근경색
• 일차적 관동맥 중재 시술
• 좌심실 기능

Language dc:language

en

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000016579
000000016579

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/10898