Predictors of beta-blocker intolerance and mortality in patients after acute coronary syndrome
Laercio Martins De Stefano1, Alex Lombardi Barbosa Ferraz, Ana Lúcia dos Anjos Ferreira
1Faculdade de Medicina de Botucatu, UNESP, Departamento de Clínica Médica, Distrito de Rubião Junior, São Paulo, Brazil.
Insights
Beta-blocker intolerance in acute coronary syndrome (ACS) patients is linked to not using statins and Killip class II. This intolerance significantly increases the risk of death within six months.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Acute coronary syndrome (ACS) management often involves beta-blockers (BBs).
- Patient intolerance to BBs can complicate treatment and affect outcomes.
- Predicting BB intolerance and its impact on mortality is crucial for patient care.
Purpose of the Study:
- To identify predictors of BB intolerance in hospitalized ACS patients.
- To assess the association between BB intolerance and 6-month mortality.
Main Methods:
- A prospective, single-center study included 370 ACS patients (Killip class I or II).
- BBs were administered per guidelines; intolerance led to withdrawal.
- Logistic regression analyzed predictors of intolerance and mortality.
Main Results:
- BB intolerance occurred in 84 patients.
- Predictors included no prior statin use (OR: 2.16) and Killip class II (OR: 2.5).
- BB intolerance was strongly associated with increased 6-month mortality (OR: 4.5).
Conclusions:
- Early BB intolerance (within 48h) in ACS patients is associated with prior statin non-use and Killip class II.
- BB intolerance significantly elevates the risk of 6-month mortality post-ACS.
Purpose:
To investigate the predictors of intolerance to beta-blockers treatment and the 6-month mortality in hospitalized patients with acute coronary syndrome (ACS).
Methods:
This was a single-center, prospective, and longitudinal study including 370 consecutive ACS patients in Killip class I or II. BBs were prescribed according to international guidelines and withdrawn if intolerance occurred. The study was approved by the institutional ethics committee of our university.
Statistics:
the clinical parameters evaluated at admission, and the related intolerance to BBs and death at 6 months were analyzed using logistic regression (p<0.05)in PATIENTS.
Results:
BB intolerance was observed in 84 patients and was associated with no prior use of statins (OR: 2.16, 95%CI: 1.26-3.69, p= 0.005) and Killip class II (OR: 2.5, 95%CI: 1.30-4.75, p=0.004) in the model adjusted for age, sex, blood pressure, and renal function. There was no association with ST-segment alteration or left anterior descending coronary artery plaque. Intolerance to BB was associated with the greatest risk of death (OR: 4.5, 95%CI: 2.15-9.40, p<0.001).
Conclusions:
After ACS, intolerance to BBs in the first 48 h of admission was associated to non previous use of statin and Killip class II and had a high risk of death within 6 months.
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