Early beta-blocker therapy improves in-hospital mortality of patients with non-ST-segment elevation myocardial
Moritz Mirna1, Alexander Berezin1, Lukas Schmutzler1
1Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Austria.
Insights
Early beta-blocker therapy for non-ST-segment elevation myocardial infarction (NSTEMI) significantly reduces in-hospital mortality. This meta-analysis suggests a beneficial effect, similar to STEMI patients, though more studies are needed.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Current guidelines recommend early beta-blocker use in STEMI but not NSTEMI.
- This study investigates the efficacy of early beta-blocker therapy in NSTEMI patients.
Approach:
- A systematic literature search was performed across multiple databases.
- Four retrospective observational studies with 184,951 patients were included.
- Meta-analysis used random effects models to compare early beta-blockers with no beta-blocker treatment.
Key Points:
- Early beta-blocker therapy significantly reduced in-hospital mortality (OR 0.43 [0.36-0.51]).
- No significant effect was observed on the prevalence of cardiogenic shock (OR 0.36 [0.07-1.91]).
Conclusions:
- Early beta-blocker treatment in NSTEMI is associated with reduced in-hospital mortality.
- The findings suggest potential benefits comparable to STEMI patients, warranting further investigation.
- A limitation is the small number of included studies (k=4).
Background:
Although current guidelines endorse early beta-blocker therapy in stable patients with STEMI, there is no clear recommendation on the early use of these drugs in patients with NSTEMI.
Methods:
Literature search was conducted by 3 independent researchers using PubMed/MEDLINE, CDSR, CENTRAL, CCAs, EBM Reviews, Web of Science and LILACS. Studies were eligible if (P) patients included were ≥ 18 years of age and had non-ST-segment elevation myocardial infarction (NSTEMI), (I) early (<24 h) treatment with intravenous or oral beta-blockers was compared to (C) no treatment with beta-blockers and data on (O) in-hospital mortality and/or in-hospital cardiogenic shock were depicted. Odds ratios and 95% confidence intervals were calculated using random effects models with the Mantel-Haenszel method. The Hartung-Knapp-Sidik-Jonkman method was used as estimator for τ2.
Results:
977 records were screened for eligibility, which led to the inclusion of 4 retrospective, nonrandomized, observational cohort studies comprising a total of N = 184,951 patients. After pooling of the effect sizes, early therapy with beta-blockers resulted in a reduction of in-hospital mortality (OR 0.43 [0.36-0.51], p = 0.0022) despite no significant effect on the prevalence of cardiogenic shock (OR 0.36 [0.07-1.91], p = 0.1196).
Conclusion:
Early treatment with beta-blockers was associated with an attenuation of in-hospital mortality despite no increase in cardiogenic shock. Thus, early therapy with these drugs could elicit beneficial effects on top of reperfusion therapy, similar to the effects seen in STEMI-patients. The low number of studies (k = 4) has to be considered when interpreting the findings of this analysis.
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