Zhang Heng, Yuan Xin, Zhang Haibo, Chen Sipeng, Zhao Yan, Hua Kun, Rao Chenfei, Wang Wei, Sun Hansong, Hu Shengshou, Zheng Zhe
From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
Circulation. 2015 Jun 23;131(25):2194-201. doi: 10.1161/CIRCULATIONAHA.114.014209. Epub 2015 Apr 23.
Conflicting results from recent observational studies have raised questions concerning the benefit of β-blockers for patients undergoing coronary artery bypass grafting (CABG). Furthermore, the efficacy of long-term β-blocker therapy in CABG patients after hospital discharge is uncertain.
The study included 5926 consecutive patients who underwent CABG and were discharged alive. The prevalence and consistency of β-blocker use were determined in patients with and without a history of myocardial infarction (MI). β-Blockers were always used in 1280 patients (50.9%) with and 1642 patients (48.1%) without previous MI after CABG. Compared with always users (n=2922, 49.3%), the risk of all-cause death was significantly higher among inconsistent β-blocker users (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.50-2.57), and never using β-blockers was associated with increased risk of both all-cause death (HR, 1.42; 95% CI, 1.01-2.00) and the composite of adverse cardiovascular events (HR, 1.29; 95% CI, 1.10-1.50). In the cohort without MI, the HR for all-cause death was 1.70 (95% CI, 1.17-2.48) in inconsistent users and 1.23 (95% CI, 0.76-1.99) in never users. In the MI cohort, mortality was higher for inconsistent users (HR, 2.14; 95% CI, 1.43-3.20) and for never users (HR, 1.59; 95% CI, 1.07-2.63). Consistent results were obtained in equivalent sensitivity analyses.
In patients with or without previous MI undergoing CABG, the consistent use of β-blockers was associated with a lower risk of long-term mortality and adverse cardiovascular events. Strategies should be developed to understand and improve discharge prescription of β-blockers and long-term patient adherence.
近期观察性研究结果相互矛盾，引发了关于β受体阻滞剂对接受冠状动脉旁路移植术（CABG）患者益处的疑问。此外，CABG患者出院后长期β受体阻滞剂治疗的疗效尚不确定。
该研究纳入了5926例连续接受CABG且存活出院的患者。在有和没有心肌梗死（MI）病史的患者中确定β受体阻滞剂使用的患病率和一致性。CABG后，1280例有既往MI的患者（50.9%）和1642例无既往MI的患者（48.1%）始终使用β受体阻滞剂。与始终使用者（n = 2922，49.3%）相比，β受体阻滞剂使用不一致的患者全因死亡风险显著更高（风险比[HR]，1.96；95%置信区间[CI]，1.50 - 2.57），从未使用β受体阻滞剂与全因死亡风险增加（HR，1.42；95% CI，1.01 - 2.00）和不良心血管事件复合风险增加（HR，1.29；95% CI，1.10 - 1.50）相关。在无MI的队列中，使用不一致的患者全因死亡HR为1.70（95% CI，1.17 - 2.48），从未使用者为1.23（95% CI，0.76 - 1.99）。在MI队列中，使用不一致的患者死亡率更高（HR，2.14；95% CI，1.43 - 3.20），从未使用者更高（HR，1.59；95% CI，1.07 - 2.63）。在等效敏感性分析中获得了一致的结果。
在有或无既往MI且接受CABG的患者中，持续使用β受体阻滞剂与较低的长期死亡率和不良心血管事件风险相关。应制定策略以了解并改善β受体阻滞剂的出院处方及患者长期依从性。
