Kjekshus J, Gilpin E, Cali G, Blackey A R, Henning H, Ross J
Department of Medicine, University of California, San Diego Medical Center, Veterans Administration Hospital.
Eur Heart J. 1990 Jan;11(1):43-50. doi: 10.1093/oxfordjournals.eurheartj.a059591.
Whether diabetic patients may benefit, compared with non-diabetic patients, from beta-blocker therapy following acute myocardial infarction was examined in a large multicentre cohort of 2024 patients, including 340 diabetics, 281 of whom survived hospitalization. One-year mortality following discharge was 17% for diabetics compared with 10% for non-diabetics (P less than 0.001). However, diabetics discharged on beta-blockers had a 1-year mortality of only 10%, compared with 23% for diabetics not on beta-blockers. In non-diabetics, mortality rates were 7% and 13% for those taking and not taking beta-blockers, respectively. Bias in patient selection for beta-blocker therapy might be responsible for the trends exhibited in our population since patients were not randomized to treatment. In diabetics, evidence of pulmonary congestion on X-ray was more prevalent than in non-diabetics; this appeared to be true both for patients taking beta-blockers and for those not taking beta-blockers. However, even in diabetics without evidence of pulmonary congestion on X-ray, 1-year mortality was 7% vs 17% for those with and without beta-blocker therapy, respectively (P less than 0.04). In multivariate analysis, beta-blocker use was an independent predictor of 1-year cardiac survival following hospital discharge for all diabetics, even those without evidence for pulmonary congestion on X-ray, but not for non-diabetics. These data suggest a beneficial effect, but a definitive answer regarding the benefit of beta-blockade in diabetic patients after acute myocardial infarction would require a prospective, randomized study.
在一个由2024名患者组成的大型多中心队列中，研究了糖尿病患者与非糖尿病患者相比，在急性心肌梗死后接受β受体阻滞剂治疗是否有益。该队列包括340名糖尿病患者，其中281名存活至出院。糖尿病患者出院后的一年死亡率为17%，而非糖尿病患者为10%（P<0.001）。然而，出院时服用β受体阻滞剂的糖尿病患者一年死亡率仅为10%，未服用β受体阻滞剂的糖尿病患者为23%。在非糖尿病患者中，服用和未服用β受体阻滞剂的死亡率分别为7%和13%。由于患者未被随机分配接受治疗，β受体阻滞剂治疗的患者选择偏差可能是导致我们研究人群中出现这种趋势的原因。在糖尿病患者中，X线显示肺充血的证据比非糖尿病患者更普遍；这在服用和未服用β受体阻滞剂的患者中似乎都是如此。然而，即使在X线无肺充血证据的糖尿病患者中，接受和未接受β受体阻滞剂治疗的患者一年死亡率分别为7%和17%（P<0.04）。多变量分析显示，对于所有糖尿病患者，即使是那些X线无肺充血证据的患者，出院后使用β受体阻滞剂也是一年心脏存活的独立预测因素，但对非糖尿病患者则不是。这些数据表明有有益作用，但关于急性心肌梗死后糖尿病患者使用β受体阻滞剂的益处的确切答案需要进行前瞻性随机研究。
