Intravenous beta-blocker therapy in ST-segment elevation myocardial infarction treated with primary percutaneous

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Moman A Mohammad1, Pontus Andell, Sasha Koul

  • 1Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|March 1, 2017
PubMed

Insights

Intravenous beta-blockers in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) were linked to increased 30-day mortality and in-hospital complications. This suggests a need to re-evaluate their routine use in this specific patient group.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacology

Background:

  • ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular event.
  • Dual antiplatelet therapy (DAPT) and primary percutaneous coronary intervention (PCI) are standard treatments for STEMI.
  • The role of intravenous (IV) beta-blockers in STEMI patients receiving DAPT and primary PCI requires clarification.

Purpose of the Study:

  • To investigate the impact of IV beta-blocker therapy on short-term mortality in STEMI patients.
  • To assess the association of IV beta-blockers with in-hospital events, including cardiogenic shock and left ventricular ejection fraction (LVEF) post-PCI.
  • To evaluate the safety and efficacy of IV beta-blockers in the context of modern STEMI management.

Main Methods:

  • Analysis of the nationwide Swedish SWEDEHEART registry (2006-2013).
  • Inclusion of STEMI patients undergoing primary PCI, excluding those with cardiogenic shock or cardiac arrest at presentation.
  • Multivariable regression and propensity score matching to adjust for confounders; primary endpoint: 30-day mortality; secondary endpoints: in-hospital mortality, cardiogenic shock, and LVEF <40%.

Main Results:

  • 17.0% of 16,909 STEMI patients received IV beta-blockers.
  • Adjusted analysis revealed higher 30-day all-cause mortality (HR: 1.44) in the IV beta-blocker group.
  • Increased risk of in-hospital cardiogenic shock (OR: 1.53) and lower LVEF (<40%) at discharge (OR: 1.70) were observed with IV beta-blocker use.

Conclusions:

  • IV beta-blocker use in STEMI patients undergoing primary PCI is associated with increased short-term mortality.
  • Patients treated with IV beta-blockers showed a higher incidence of in-hospital cardiogenic shock and reduced LVEF at discharge.
  • Findings suggest caution regarding the routine administration of IV beta-blockers in this specific STEMI patient population.
Abstract

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