INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.
INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
Eur J Heart Fail. 2017 Feb;19(2):271-279. doi: 10.1002/ejhf.647. Epub 2016 Oct 24.
To determine the influence of baseline beta-blocker use on long-term prognosis of myocardial infarction (MI) survivors complicated with heart failure (HF) or with left ventricular dysfunction and with history of chronic obstructive pulmonary disease (COPD).
Among the 28 771 patients from the High-Risk MI Database Initiative we identified 1573 patients with a baseline history of COPD. We evaluated the association between beta-blocker use at baseline (822 with beta-blocker and 751 without) on the rates of all-cause and cardiovascular mortality. On univariable Cox analysis, beta-blocker use was found to be associated with lower rates of both all-cause [hazard ratio (HR) = 0.61, 95% confidence interval (CI) 0.51-0.75, P < 0.0001] and cardiovascular mortality (HR = 0.63, 95% CI 0.51-0.78, P < 0.0001). After extensive adjustment for confounding, including 24 baseline covariates, COPD patients still benefited from beta-blocker usage (HR = 0.73, 95% CI 0.60-0.90, P = 0.002 for all-cause mortality; HR = 0.77, 95% CI 0.61-0.97, P = 0.025 for cardiovascular mortality). Adjusting for propensity scores (PS) constructed from the 24 aforementioned baseline characteristics provided similar results. In a cohort of 561 pairs of patients taking or not taking beta-blocker matched on PS using a 1:1 nearest-neighbour matching method, patients treated with beta-blocker experienced fewer all-cause deaths (HR = 0.71, 95% CI 0.56-0.89, P = 0.003) and cardiovascular deaths (HR = 0.76, 95% CI 0.59-0.97, P = 0.032).
In the specific setting of a well-treated cohort of high-risk MI survivors, beta-blockers were associated with better outcomes in patients with COPD.
确定基线β受体阻滞剂使用对合并心力衰竭(HF)或左心室功能障碍且有慢性阻塞性肺疾病(COPD)病史的心肌梗死(MI)幸存者长期预后的影响。
在来自高危 MI 数据库倡议的 28771 例患者中,我们确定了 1573 例基线有 COPD 病史的患者。我们评估了基线时β受体阻滞剂使用(822 例使用β受体阻滞剂,751 例未使用)与全因和心血管死亡率之间的关系。单变量 Cox 分析显示,β受体阻滞剂的使用与全因死亡率[危险比(HR)=0.61,95%置信区间(CI)0.51-0.75,P<0.0001]和心血管死亡率(HR=0.63,95%CI 0.51-0.78,P<0.0001)均呈负相关。在广泛调整混杂因素后,包括 24 项基线协变量,COPD 患者仍从β受体阻滞剂的使用中获益(全因死亡率 HR=0.73,95%CI 0.60-0.90,P=0.002;心血管死亡率 HR=0.77,95%CI 0.61-0.97,P=0.025)。根据上述 24 项基线特征构建倾向评分(PS)并进行调整,结果相似。在使用 1:1 最近邻匹配方法按 PS 匹配的 561 对接受或不接受β受体阻滞剂治疗的患者队列中,接受β受体阻滞剂治疗的患者全因死亡人数较少(HR=0.71,95%CI 0.56-0.89,P=0.003),心血管死亡人数也较少(HR=0.76,95%CI 0.59-0.97,P=0.032)。
在高危 MI 幸存者经过良好治疗的特定环境中,β受体阻滞剂与 COPD 患者的更好结局相关。