Cuculi F, Radovanovic D, Pedrazzini G, Regli M, Urban P, Stauffer J C, Erne P
Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Cardiology. 2010;115(2):91-7. doi: 10.1159/000256384. Epub 2009 Nov 7.
The role of beta-blockers in the treatment of hypertension is discussed controversially and the data showing a clear benefit in acute coronary syndromes (ACS) were obtained in the thrombolysis era. The goal of this study was to analyze the role of pretreatment with beta-blockers in patients with ACS.
Using data from the Acute Myocardial Infarction in Switzerland (AMIS Plus) registry, we analyzed outcomes of patients with beta-blocker pretreatment in whom they were continued during hospitalization (group A), those without beta-blocker pretreatment but with administration after admission (group B) and those who never received them (group C). Major adverse cardiac events defined as composed endpoint of re-infarction and stroke (during hospitalization) and/or in-hospital death were compared between the groups.
A total of 24,709 patients were included in the study (6,234 in group A, 12,344 in group B, 6,131 in group C). Patients of group B were younger compared to patients of group A and C (62.5, 67.6 and 68.4, respectively). In the multivariate analysis, odds ratio for major adverse cardiac events was 0.59 (CI 0.47-0.74) for group A and 0.66 (CI 0.55-0.83) for group B, while group C was taken as a reference.
beta-Blocker therapy is beneficial in ACS and they should be started in those who are not pretreated and continued in stable patients who had been on chronic beta-blocker therapy before.
β受体阻滞剂在高血压治疗中的作用存在争议，且在溶栓时代获得的有关其在急性冠脉综合征（ACS）中具有明显益处的数据。本研究的目的是分析ACS患者中β受体阻滞剂预处理的作用。
利用瑞士急性心肌梗死（AMIS Plus）登记处的数据，我们分析了β受体阻滞剂预处理患者在住院期间继续使用的结局（A组）、未进行β受体阻滞剂预处理但入院后使用的患者（B组）以及从未接受过β受体阻滞剂治疗的患者（C组）。比较各组间定义为再梗死和中风（住院期间）及/或住院死亡的复合终点的主要不良心脏事件。
本研究共纳入24,709例患者（A组6,234例，B组12,344例，C组6,131例）。B组患者比A组和C组患者年轻（分别为62.5岁、67.6岁和68.4岁）。在多变量分析中，A组主要不良心脏事件的比值比为0.59（95%置信区间0.47 - 0.74），B组为0.66（95%置信区间0.55 - 0.83），以C组作为对照。
β受体阻滞剂治疗对ACS有益，应在未接受预处理的患者中开始使用，并在之前接受过慢性β受体阻滞剂治疗的稳定患者中继续使用。
