Nguyen Peter, Kamran Hassan, Nasir Saifullah, Chan Wenyaw, Shah Tina, Deswal Anita, Bozkurt Biykem
Department of Internal Medicine and Cardiology, Baylor College of Medicine, Houston, Texas; Department of Internal Medicine and Cardiology, Winters Center for Heart Failure Research, Houston, Texas.
Department of Internal Medicine and Cardiology, Baylor College of Medicine, Houston, Texas.
Am J Cardiol. 2017 Jun 15;119(12):2030-2034. doi: 10.1016/j.amjcard.2017.03.034. Epub 2017 Mar 29.
Beta-blocker treatment improves left ventricular function, morbidity, and survival in patients with systolic heart failure (HF). However, there are limited data addressing the safety and efficacy of β blockers in the setting of cocaine use as there is a perceived risk of adverse outcomes. Our aim was to determine if beta-blocker treatment was safe in HF patients with a history of cocaine use compared with HF patients without history of cocaine use. We also examined whether effects differed between cardioselective versus noncardioselective β blockers. Ninety systolic HF patients with cocaine use were compared with 177 patients with nonischemic, systolic HF, and no cocaine use. Outcomes were HF readmissions, major adverse cardiovascular events, and death using multivariable Cox proportional hazard models adjusted for age, black race, hypertension, diabetes, coronary artery disease, renal insufficiency, and angiotensin-converting enzyme inhibitors. Beta-blocker treatment in systolic HF patients with cocaine use did not have significant differences in HF readmissions (hazard ratio [HR] 0.66, 95% CI 0.31 to 0.1.38), major adverse cardiovascular events (HR 0.58, 95% CI 0.27 to 1.09), death (HR 0.96, 95% CI 0.39 to 2.34), or all combined outcomes (HR 0.76, 95% CI 0.39 to 1.47) compared with beta-blocker treatment in HF patients without cocaine use. Within HF patients with cocaine use, mortality rates (HR 1.50, 95% CI 0.28 to 8.23) were not significantly different between patients treated with noncardioselective versus cardioselective β blockers. In conclusion, beta-blocker treatment in systolic HF patients with cocaine use was not associated with adverse outcomes.
β受体阻滞剂治疗可改善收缩性心力衰竭（HF）患者的左心室功能、发病率和生存率。然而，关于β受体阻滞剂在可卡因使用情况下的安全性和有效性的数据有限，因为人们认为存在不良后果的风险。我们的目的是确定与无可卡因使用史的HF患者相比，有可卡因使用史的HF患者使用β受体阻滞剂治疗是否安全。我们还研究了心脏选择性与非心脏选择性β受体阻滞剂之间的效果是否存在差异。将90例有可卡因使用史的收缩性HF患者与177例无缺血性、收缩性HF且无可卡因使用史的患者进行比较。使用多变量Cox比例风险模型对年龄、黑人种族、高血压、糖尿病、冠状动脉疾病、肾功能不全和血管紧张素转换酶抑制剂进行调整后，观察结果包括HF再入院、主要不良心血管事件和死亡。有可卡因使用史的收缩性HF患者使用β受体阻滞剂治疗在HF再入院（风险比[HR]0.66，95%可信区间[CI]0.31至1.38）、主要不良心血管事件（HR0.58，95%CI0.27至1.09）、死亡（HR0.96，95%CI0.39至2.34）或所有综合结果（HR0.76，95%CI0.39至1.47）方面与无可卡因使用史的HF患者使用β受体阻滞剂治疗相比无显著差异。在有可卡因使用史的HF患者中，非心脏选择性与心脏选择性β受体阻滞剂治疗的患者死亡率（HR1.50，95%CI0.28至8.23）无显著差异。总之，有可卡因使用史的收缩性HF患者使用β受体阻滞剂治疗与不良后果无关。
