Hansen O, Johansson B W, Gullberg B
Section of Cardiology, Malmö General Hospital, Sweden.
Cardiology. 1992;80(5-6):382-91. doi: 10.1159/000175029.
To assess the effects of current treatments with beta-blockers or calcium antagonists on the clinical outcome of acute myocardial infarction (MI), enzymatically estimated infarct sizes, circulatory arrests from ventricular tachyarrhythmias, ventricular tachycardia (VT)/ventricular fibrillation (VF), and in-hospital mortality were analyzed retrospectively from 7,922 citizens of Malmö, Sweden, hospitalized due to a first MI between 1973 and 1987. Of these patients, 296 were on treatment with calcium antagonists, 393 on treatment with a beta 1-selective beta-blocker, 482 with a nonselective beta-blocker, and 95 on combined treatment with beta-blockers and calcium antagonists at the time of admission to hospital. In a set of multivariate analyses including several clinical characteristics, patients on treatment with a nonselective beta-blocker had a significantly lower peak aspartate aminotransferase (ASAT; difference -0.70 mukat/l, 95% CL: -1.24 to -0.16), whereas no significant relations between peak ASAT and treatment with cardioselective beta-blockers or calcium antagonists were found. Treatment with cardioselective beta-blockers or calcium antagonists, in contrast to treatment with a nonselective beta-blocker, were significant predictors of the occurrence of circulatory arrests from VT/VF. The relative risk of VT/VF in patients on cardioselective beta-blockers was 1.51 (95% CI: 1.12-2.03), and in patients on calcium antagonists 1.44 (95% CI: 1.03-2.02). None of the treatments were significantly associated with in-hospital mortality. In patients on beta-blockers or calcium antagonists when suffering their first MI, nonselective beta-blockade may reduce infarct size. Treatment with beta-blockers or calcium antagonists identified patients with an increased risk of circulatory arrests from VT/VF, but neither of the treatments were significantly associated with in-hospital mortality. We suggest that only minor differences exist between the effects of chronic treatment with beta-blockers and calcium antagonists on the outcome of an acute MI.
为评估当前使用β受体阻滞剂或钙拮抗剂治疗对急性心肌梗死（MI）临床结局、酶学估算梗死面积、室性快速心律失常导致的循环骤停、室性心动过速（VT）/心室颤动（VF）及住院死亡率的影响，我们对1973年至1987年间因首次MI住院的7922名瑞典马尔默市民进行了回顾性分析。这些患者中，296例正在接受钙拮抗剂治疗，393例接受β1选择性β受体阻滞剂治疗，482例接受非选择性β受体阻滞剂治疗，95例在入院时接受β受体阻滞剂与钙拮抗剂联合治疗。在一组包含多个临床特征的多变量分析中，接受非选择性β受体阻滞剂治疗的患者天门冬氨酸氨基转移酶（ASAT）峰值显著更低（差异为-0.70μkat/L，95%可信区间：-1.24至-0.16），而未发现ASAT峰值与心脏选择性β受体阻滞剂或钙拮抗剂治疗之间存在显著关联。与非选择性β受体阻滞剂治疗相比，心脏选择性β受体阻滞剂或钙拮抗剂治疗是VT/VF导致循环骤停发生的显著预测因素。接受心脏选择性β受体阻滞剂治疗患者发生VT/VF的相对风险为1.51（95%可信区间：1.12 - 2.03），接受钙拮抗剂治疗患者的相对风险为1.44（95%可信区间：1.03 - 2.02）。这些治疗均与住院死亡率无显著关联。在首次发生MI时接受β受体阻滞剂或钙拮抗剂治疗的患者中，非选择性β受体阻滞可能减小梗死面积。β受体阻滞剂或钙拮抗剂治疗可识别出VT/VF导致循环骤停风险增加的患者，但这两种治疗均与住院死亡率无显著关联。我们认为，β受体阻滞剂和钙拮抗剂的长期治疗对急性MI结局的影响仅存在微小差异。
