Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Am J Cardiol. 2013 Feb 15;111(4):457-64. doi: 10.1016/j.amjcard.2012.10.026. Epub 2012 Dec 8.
Although clinical guidelines recommend long-term β-blocker (BB) therapy to decrease mortality after acute myocardial infarction, these recommendations are based predominantly on evidence from before the reperfusion and thrombolytic eras. To investigate the effects of BB therapy for patients with acute myocardial infarctions on mortality in the percutaneous coronary intervention era, a total of 5,628 consecutive patients who were admitted <24 hours after the onset of ST-segment elevation myocardial infarction, treated with emergent percutaneous coronary intervention, and discharged alive were studied. During a median follow-up period of 1,430 days, mortality rates did not differ between patients with and without BB therapy (5.2% vs 6.2%, p = 0.786). Multivariate analysis revealed that BB treatment was not associated with a reduced risk for mortality (hazard ratio 0.935, 95% confidence interval 0.711 to 1.230, p = 0.534). The results of propensity score matching also indicated that the mortality rates did not differ between the 2 groups. However, subgroup analyses among matched populations revealed that BB treatment was associated with a significantly lower mortality risk for high-risk patients, who were defined as those with Global Registry of Acute Coronary Events (GRACE) risk scores ≥121 (hazard ratio 0.596, 95% confidence interval 0.416 to 0.854, p = 0.005) or those administered diuretics (hazard ratio 0.602, 95% confidence interval 0.398 to 0.910, p = 0.016), but not for lower risk patients. In conclusion, BB treatment was associated with reduced long-term mortality in patients after ST-segment elevation myocardial infarction at higher risk, but not in those at lower risk. Although randomized controlled studies are warranted to confirm these results, the implementation of BB therapy for discharged patients with ST-segment elevation myocardial infarction may need to be assessed on the basis of individual mortality risk in the percutaneous coronary intervention era.
尽管临床指南建议长期使用β受体阻滞剂（BB）治疗以降低急性心肌梗死后的死亡率，但这些建议主要基于再灌注和溶栓时代之前的证据。为了研究在经皮冠状动脉介入治疗时代，急性心肌梗死患者使用 BB 治疗对死亡率的影响，共研究了 5628 例连续患者，这些患者在 ST 段抬高型心肌梗死发病后 24 小时内接受紧急经皮冠状动脉介入治疗并存活出院。在中位随访期 1430 天期间，有 BB 治疗和无 BB 治疗的患者死亡率没有差异（5.2%比 6.2%，p=0.786）。多变量分析显示，BB 治疗与降低死亡率无关（风险比 0.935，95%置信区间 0.711 至 1.230，p=0.534）。倾向评分匹配的结果也表明，两组之间的死亡率没有差异。然而，匹配人群的亚组分析表明，BB 治疗与高危患者的死亡率显著降低相关，高危患者定义为全球急性冠状动脉事件登记（GRACE）风险评分≥121（风险比 0.596，95%置信区间 0.416 至 0.854，p=0.005）或接受利尿剂治疗的患者（风险比 0.602，95%置信区间 0.398 至 0.910，p=0.016），但对低危患者则不然。总之，BB 治疗与 ST 段抬高型心肌梗死高危患者的长期死亡率降低相关，但与低危患者无关。尽管需要随机对照研究来证实这些结果，但在经皮冠状动脉介入治疗时代，可能需要根据个体死亡率风险来评估对出院的 ST 段抬高型心肌梗死患者使用 BB 治疗。
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