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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
β-Blocker Therapy in the Era of Primary Percutaneous Intervention for ST Elevation Myocardial Infarction
You-Hong Lee1, Jin-Sun Park, Seung-Jea Tahk
1Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea.
Insights
Beta-blockers significantly improve outcomes for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). These benefits persist regardless of left ventricular ejection fraction (LVEF), reducing both death and major adverse cardiac events.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- The role of beta-blockers in ST-elevation myocardial infarction (STEMI) management following primary percutaneous coronary intervention (PCI) remains a subject of clinical debate.
- Despite advances in reperfusion therapies, optimizing secondary prevention strategies is crucial for improving patient prognosis.
Purpose of the Study:
- To evaluate the clinical efficacy of beta-blockers in patients with STEMI treated with primary PCI.
- To assess the impact of beta-blockers on mortality and major adverse cardiac events (MACE) across different left ventricular ejection fraction (LVEF) subgroups.
Main Methods:
- A cohort of 901 STEMI patients undergoing primary PCI was analyzed.
- Patients were categorized into beta-blocker (n=598) and non-beta-blocker (n=303) groups for comparative outcome analysis.
- Propensity score matching was employed to control for baseline characteristic differences, followed by Kaplan-Meier survival analysis.
Main Results:
- The beta-blocker group exhibited significantly lower all-cause death (10.0% vs 25.4%, p<0.001) and MACE (22.1% vs 34.3%, p<0.001) compared to the non-beta-blocker group.
- Beta-blocker use was associated with reduced all-cause death in both low LVEF (<50%) and normal LVEF (≥50%) subgroups (HR 0.55, p=0.009 and HR 0.50, p=0.016, respectively).
- Kaplan-Meier analysis post-propensity matching confirmed lower mortality in the beta-blocker group for both low and normal LVEF patients (p=0.02 and p=0.001, respectively).
Conclusions:
- Beta-blockers demonstrate significant clinical benefits in STEMI patients treated with primary PCI.
- The positive impact of beta-blockers on clinical outcomes is evident irrespective of the patient's left ventricular ejection fraction.
- These findings support the continued use of beta-blockers as a key therapeutic strategy in acute myocardial infarction management.
Objectives:
With the present therapeutic advances in the era of primary percutaneous coronary intervention (PCI), the role of β-blockers in ST elevation acute myocardial infarction (STEMI) has remained contentious.
Methods:
We analyzed the data and clinical outcomes of 901 STEMI patients who had undergone primary PCI. We classified the patients into β-blocker (n = 598) and non-β-blocker groups (n = 303).
Results:
The cumulative incidence of all-cause death was 10.0% in the β-blocker group and 25.4% in the non-β-blocker group (p < 0.001). The incidence of major adverse cardiac events (MACE) was 22.1% in the β-blocker group and 34.3% in the non-β-blocker group (p < 0.001). The relative hazard ratio (HR) of β-blockers for all-cause death and MACE with low left ventricle ejection fraction (LVEF; <50%) was 0.55 [95% confidence interval (CI) 0.35-0.86, p = 0.009] and 0.75 (95% CI 0.51-1.09, p = 0.125), respectively. In patients with normal LVEF (≥50%), the relative HR of β-blockers for death and MACE were 0.50 (95% CI 0.29-0.88, p = 0.016) and 0.75 (95% CI 0.51-1.12, p = 0.162), respectively. After propensity score matching of the difference of the baseline characteristics, the Kaplan-Meier survival curve demonstrated lower mortality in the β-blocker group than in the non-β-blocker group with both low LVEF and normal LVEF (p = 0.02 and p = 0.001, respectively).
Conclusions:
β-Blockers have beneficial clinical outcomes in the era of primary PCI for STEMI, regardless of the LVEF. © 2015 S. Karger AG, Basel.
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