心肌梗塞后的β-阻塞剂与正常的喷射分数
Anna Meta Dyrvig Kristensen1, Xavier Rossello2,3,4,5, Dan Atar6,7
1Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen.
The New England journal of medicine
|November 10, 2025
概括
在心肌梗塞后保持左心室喷射分数 (LVEF) 的患者中,β-阻断剂治疗没有显著降低死亡,心肌梗塞或心力衰竭的风险. 这一发现挑战了在这个特定的患者群体中常规使用β抑制剂.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 药理学 药理学是指药理学的学科.
背景情况:
- 在心肌梗塞后患有保存左心室喷射分数 (LVEF) 的患者中,β阻塞剂的疗效仍然不确定.
- 目前的指导方针并不总是建议对所有心肌梗塞后患者进行β阻塞疗法,特别是那些正常LVEF的患者.
研究的目的:
- 评估贝塔阻断剂治疗在患有心肌梗塞和左心室喷射率 (LVEF) 至少50%的患者中的有效性.
- 为了确定β-阻塞剂是否会降低这一特定人群中死亡,心肌梗塞或心力衰竭的复合终点.
主要方法:
- 五项随机对照试验的个人患者数据元分析.
- 纳入标准:最近的心肌梗塞,LVEF ≥50%,没有其他β-阻断剂的指示.
- 主要终点:综合所有死因,心肌梗塞或心力衰竭,使用Cox比例风险模型进行分析.
主要成果:
- 分析了17,801名患者 (8831人接受β阻塞剂,8970人没有),随访时间中位数为3.6年.
- 在β-阻断剂和非β-阻断剂组之间的初级复合终点没有显著差异 (HR,0.97;95% CI,0.87-1.07).
- 对所有死因,心肌梗塞和心力衰竭的亚组分析也显示没有显著的益处.
结论:
- 在患有心肌梗塞和保持LVEF的患者中,β-阻断剂治疗没有显示死亡,心肌梗塞或心力衰竭的复合终点的减少.
- 这些发现表明,在没有其他令人信服的迹象的情况下,常规使用β-阻断剂可能对心肌梗塞和LVEF50%或以上的患者无益.
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