Impact of beta blockade therapy on long-term mortality after ST-segment elevation acute myocardial infarction in the
Daisaku Nakatani1, Yasuhiko Sakata, Shinichiro Suna
1Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Insights
Long-term beta-blocker (BB) therapy after myocardial infarction shows reduced mortality risk only in high-risk patients. Lower-risk patients did not benefit, suggesting personalized risk assessment for BB use in the percutaneous coronary intervention era.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Clinical guidelines recommend long-term beta-blocker (BB) therapy post-myocardial infarction (MI).
- These recommendations predate the widespread use of reperfusion therapies like percutaneous coronary intervention (PCI).
- The efficacy of BBs in the modern PCI era requires re-evaluation.
Purpose of the Study:
- To investigate the long-term effects of BB therapy on mortality in ST-segment elevation myocardial infarction (STEMI) patients treated with emergent PCI.
- To determine if BB therapy provides a mortality benefit in the current treatment landscape.
Main Methods:
- A cohort of 5,628 STEMI patients treated with emergent PCI and discharged alive was studied.
- Patients were followed for a median of 1,430 days.
- Multivariate analysis and propensity score matching were used to assess the association between BB therapy and mortality.
Main Results:
- Overall mortality rates did not differ significantly between patients with and without BB therapy (5.2% vs 6.2%, p=0.786).
- Multivariate analysis showed no reduced mortality risk associated with BB treatment (HR 0.935, p=0.534).
- Subgroup analysis revealed BBs significantly reduced mortality in high-risk patients (GRACE score ≥121 or on diuretics), but not in lower-risk patients.
Conclusions:
- Beta-blocker therapy is associated with reduced long-term mortality in high-risk STEMI patients post-PCI.
- BB therapy did not demonstrate a significant mortality benefit for lower-risk STEMI patients in this cohort.
- Individualized risk assessment may be necessary to guide BB therapy decisions in the PCI era.
Abstract:
Although clinical guidelines recommend long-term β-blocker (BB) therapy to decrease mortality after acute myocardial infarction, these recommendations are based predominantly on evidence from before the reperfusion and thrombolytic eras. To investigate the effects of BB therapy for patients with acute myocardial infarctions on mortality in the percutaneous coronary intervention era, a total of 5,628 consecutive patients who were admitted <24 hours after the onset of ST-segment elevation myocardial infarction, treated with emergent percutaneous coronary intervention, and discharged alive were studied. During a median follow-up period of 1,430 days, mortality rates did not differ between patients with and without BB therapy (5.2% vs 6.2%, p = 0.786). Multivariate analysis revealed that BB treatment was not associated with a reduced risk for mortality (hazard ratio 0.935, 95% confidence interval 0.711 to 1.230, p = 0.534). The results of propensity score matching also indicated that the mortality rates did not differ between the 2 groups. However, subgroup analyses among matched populations revealed that BB treatment was associated with a significantly lower mortality risk for high-risk patients, who were defined as those with Global Registry of Acute Coronary Events (GRACE) risk scores ≥121 (hazard ratio 0.596, 95% confidence interval 0.416 to 0.854, p = 0.005) or those administered diuretics (hazard ratio 0.602, 95% confidence interval 0.398 to 0.910, p = 0.016), but not for lower risk patients. In conclusion, BB treatment was associated with reduced long-term mortality in patients after ST-segment elevation myocardial infarction at higher risk, but not in those at lower risk. Although randomized controlled studies are warranted to confirm these results, the implementation of BB therapy for discharged patients with ST-segment elevation myocardial infarction may need to be assessed on the basis of individual mortality risk in the percutaneous coronary intervention era.
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