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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
The selection of β-blocker after successful reperfusion in patients with ST-elevation myocardial infarction
Ho-Jun Jang1, Jon Suh2, Sung Woo Kwon3
1Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon-si, Republic of Korea.
Insights
Carvedilol use in ST-elevation myocardial infarction survivors is linked to fewer recurrent heart attacks and revascularization procedures. This suggests carvedilol may be a superior beta-blocker choice for secondary prevention after primary PCI.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Optimizing beta-blocker selection is critical for survivors of acute ST-elevation myocardial infarction (STEMI) following primary intervention.
- Limited comparative data exists for beta-blocker effectiveness in this patient population.
Purpose of the Study:
- To compare the effectiveness of selective beta-blockers against carvedilol in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- A retrospective analysis of 1,485 patients from the "INTERSTELLAR" registry (2007-2015).
- Compared outcomes between 238 patients on selective beta-blockers (bisoprolol, nebivolol, atenolol, bevantolol, betaxolol) and 988 on carvedilol over a 2-year period.
- Propensity score matching was used to adjust for baseline differences.
Main Results:
- Carvedilol group showed significantly lower rates of recurrent myocardial infarction (MI) (1.2% vs. 4.6%) and target vessel revascularization (TVR) (0.9% vs. 4.2%) compared to selective beta-blockers (p<0.001 for both).
- Mortality and stroke rates did not differ significantly between the groups.
- After propensity matching, carvedilol remained associated with lower recurrent MI (1.2% vs. 5.0%) and TVR (0.7% vs. 4.5%).
- Carvedilol use was an independent predictor for reduced recurrent MI (HR=0.305, p=0.005).
Conclusions:
- Carvedilol use in STEMI survivors treated with primary PCI is associated with a reduced risk of recurrent myocardial infarction.
- Carvedilol may represent a preferred beta-blocker option for secondary prevention in this patient cohort.
Background:
The selection of β-blocker for survivors after primary intervention due to acute ST-elevation myocardial infarction seems crucial to improve the outcomes. However, rare comparison data existed for these patients. We aimed to compare the effectiveness of selective β-blockers to that of carvedilol in patients treated with primary intervention.
Methods And Results:
Among the 1,485 patients in the "INTERSTELLAR" registry between 2007 and 2015, 238 patients with selective β-blockers (bisoprolol, nebivolol, atenolol, bevantolol, and betaxolol) and 988 with carvedilol were included and their clinical outcomes were compared for a 2-year observation period. In the clinical baseline characteristics, the unfavorable trends in the carvedilol group were high Killip presentation, lower ejection fractions, smaller diameters, and longer lengths of deployed stents. Although mortality (2.5% vs. 1.7%; p = 0.414) and the rate of stroke (0.8% vs. 0.6%; p = 0.693) were not different between groups, the rate of recurrent myocardial infarction (4.6% vs. 1.2%; p = 0.001) and of target vessel revascularization (4.2% vs. 0.9%; p < 0.001) were lower in the carvedilol group. After eliminating the difference by propensity matching, the similar outcome result was shown (all-cause death, 0.6% vs. 1.0%, p = 0.678; stroke, 0.6% vs. 1.2%, p = 0.479; myocardial infarction, 5.0% vs. 1.2%, p = 0.003; target vessel revascularization, 4.5% vs. 0.7%, p < 0.006) for 595 matched populations. The use of carvedilol was also determined to be an independent predictor for recurrent myocardial infarctions (hazard ratio = 0.305; p = 0.005; 95% confidence interval = 0.13-0.69).
Conclusion:
Use of a carvedilol in ST-segment myocardial infarction survivor is associated with lower recurrent myocardial infarction events. Thus, it might be the better choice of β-blocker for secondary prevention in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention.
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