Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea.
J Am Heart Assoc. 2017 Oct 24;6(10):e007063. doi: 10.1161/JAHA.117.007063.
Although current guidelines recommend β-blocker after acute myocardial infarction (MI), the role of β-blocker has not been well investigated in the modern reperfusion era. In particular, the benefit of vasodilating β-blocker over conventional β-blocker is still unexplored.
Using nation-wide multicenter Korean Acute Myocardial Infarction Registry data, we analyzed clinical outcomes of 7127 patients with acute MI who underwent successful percutaneous coronary intervention with stents and took β-blockers: vasodilating β-blocker (n=3482), and conventional β-blocker (n=3645). In the whole population, incidence of cardiac death at 1 year was significantly lower in the vasodilating β-blocker group (vasodilating β-blockers versus conventional β-blockers, 1.0% versus 1.9%; 0.003). In 2882 pairs of propensity score-matched population, the incidence of cardiac death was significantly lower in the vasodilating β-blocker group (1.1% versus 1.8%; 0.028). Although incidences of MI (1.1% versus 1.5%; 0.277), any revascularization (2.8% versus 3.0%; 0.791), and hospitalization for heart failure (1.4% versus 1.9%; 0.210) were not different between the 2 groups, incidences of cardiac death or MI (2.0% versus 3.1%; 0.010), cardiac death, MI, or hospitalization for heart failure (3.0% versus 4.5%; 0.003), cardiac death, MI, or any revascularization (3.9% versus 5.3%; 0.026), and cardiac death, MI, any revascularization, or hospitalization for heart failure (4.8% versus 6.5%; 0.011) were significantly lower in the vasodilating β-blocker group.
Vasodilating β-blocker therapy resulted in better clinical outcomes than conventional β-blocker therapy did in patients with acute MI in the modern reperfusion era. Vasodilating β-blockers could be recommended preferentially to conventional ones for acute MI patients.
尽管目前的指南建议急性心肌梗死（MI）后使用β受体阻滞剂，但在现代再灌注时代，β受体阻滞剂的作用尚未得到充分研究。特别是，血管扩张性β受体阻滞剂相对于传统β受体阻滞剂的益处仍未得到探索。
利用全国多中心韩国急性心肌梗死注册数据，我们分析了 7127 例接受成功经皮冠状动脉介入治疗并服用β受体阻滞剂的急性 MI 患者的临床结局：血管扩张性β受体阻滞剂（n=3482）和传统β受体阻滞剂（n=3645）。在全人群中，血管扩张性β受体阻滞剂组 1 年时心脏死亡的发生率显著降低（血管扩张性β受体阻滞剂与传统β受体阻滞剂相比，1.0%与 1.9%；0.003）。在 2882 对倾向评分匹配人群中，血管扩张性β受体阻滞剂组心脏死亡的发生率显著降低（1.1%与 1.8%；0.028）。尽管两组间 MI 的发生率（1.1%与 1.5%；0.277）、任何血运重建的发生率（2.8%与 3.0%；0.791）和心力衰竭住院率（1.4%与 1.9%；0.210）无差异，但两组间心脏死亡或 MI 的发生率（2.0%与 3.1%；0.010）、心脏死亡、MI 或心力衰竭住院率（3.0%与 4.5%；0.003）、心脏死亡、MI 或任何血运重建率（3.9%与 5.3%；0.026）以及心脏死亡、MI、任何血运重建或心力衰竭住院率（4.8%与 6.5%；0.011）均显著降低。
在现代再灌注时代，血管扩张性β受体阻滞剂治疗急性 MI 患者的临床结局优于传统β受体阻滞剂。血管扩张性β受体阻滞剂可优先推荐用于急性 MI 患者。
