Isogai Toshiaki, Matsui Hiroki, Tanaka Hiroyuki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Heart. 2016 Jul 1;102(13):1029-35. doi: 10.1136/heartjnl-2015-308712. Epub 2016 Feb 15.
A catecholamine-mediated mechanism has been implicated in the pathogenesis of Takotsubo cardiomyopathy (TC). However, the impact of β-blockers in acute-phase management of TC remains uncertain. This study aimed to examine whether early β-blocker use in TC was associated with lower in-hospital mortality.
This was a retrospective cohort study using the Diagnosis Procedure Combination nationwide inpatient database in Japan. Patients with TC aged ≥20 years who were admitted to acute-care hospitals between 2010 and 2014 were identified. Thirty-day in-hospital mortality was compared between patients who started β-blocker therapy on hospitalisation day 1 or 2 (early β-blocker group) and those who did not receive a β-blocker during hospitalisation (control group) using propensity score-matching and instrumental variable analyses.
Of 2672 eligible patients (female, 81.5%; 423 early β-blocker therapy, 2249 controls) from 615 hospitals, 1:4 propensity score-matching created a cohort of 2110 patients (422 early β-blocker therapy, 1688 controls). There was no significant difference in 30-day in-hospital mortality between the early β-blocker group and control group (2.4% vs 2.0%, p=0.703; risk difference, 0.4%; 95% CI, -1.2% to 2.0%). Logistic regression analysis did not show a significant association between early β-blocker use and 30-day in-hospital mortality (OR, 1.17; 95% CI 0.58 to 2.37). Instrumental variable analysis also found that early β-blocker use was not associated with lower 30-day in-hospital mortality (risk difference, 1.2%; 95% CI -3.1% to 5.5%).
This study found no significant association between early β-blocker use and in-hospital mortality in patients with TC.
儿茶酚胺介导的机制与Takotsubo心肌病（TC）的发病机制有关。然而，β受体阻滞剂在TC急性期管理中的作用仍不确定。本研究旨在探讨早期使用β受体阻滞剂治疗TC是否与降低住院死亡率相关。
这是一项回顾性队列研究，使用日本全国住院患者诊断程序组合数据库。确定2010年至2014年间入住急症医院的年龄≥20岁的TC患者。使用倾向评分匹配和工具变量分析，比较在住院第1天或第2天开始使用β受体阻滞剂治疗的患者（早期β受体阻滞剂组）和住院期间未接受β受体阻滞剂治疗的患者（对照组）的30天住院死亡率。
来自615家医院的2672例符合条件的患者（女性，81.5%；423例接受早期β受体阻滞剂治疗，2249例为对照组），1:4倾向评分匹配产生了一个2110例患者的队列（422例接受早期β受体阻滞剂治疗，1688例为对照组）。早期β受体阻滞剂组和对照组的30天住院死亡率无显著差异（2.4%对2.0%，p=0.703；风险差异，0.4%；95%CI，-1.2%至2.0%）。逻辑回归分析未显示早期使用β受体阻滞剂与30天住院死亡率之间存在显著关联（OR，1.17；95%CI 0.58至2.37）。工具变量分析还发现，早期使用β受体阻滞剂与降低30天住院死亡率无关（风险差异，1.2%；95%CI -3.1%至5.5%）。
本研究发现早期使用β受体阻滞剂与TC患者的住院死亡率之间无显著关联。
