1 Division of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan.
2 Cardiothoracic and Vascular Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan.
J Am Heart Assoc. 2018 Oct 2;7(19):e008982. doi: 10.1161/JAHA.118.008982.
Background It is not clear whether β-selective or nonselective β-blockers should be used in patients with cirrhosis and acute myocardial infarction. Methods and Results Medical records were retrieved from Taiwan NHIRD (National Health Insurance Research Database) during 2001-2013. Patients were excluded for age <20, previous acute myocardial infarction, contraindication to β-blockers, chronic obstructive pulmonary disease, asthma, or atrioventricular conduction disease. Patients who died during index admission, had a follow-up <6 months, had a medication ratio of either β-selective or nonselective β-blocker <80%, or who switched between β-blockers were also excluded. Patients on β-selective blockers and nonselective β-blockers were propensity score matched and compared for outcome. Primary outcomes were 1- and 2-year cardiovascular events, liver adverse outcomes, and all-cause mortality. A total of 203 595 patients with acute myocardial infarction were enrolled, of whom 6355 had cirrhosis. After screening for exclusion criteria, 1769 patients (655 patients on β-blockers and 1114 patients not on β-blockers) were eligible for analysis. Among patients on β-blockers, propensity score matching was performed, and 218 patients on β-selective blockers and 218 patients on nonselective β-blockers were studied. During a 2-year follow-up, patients on β-selective blockers had significantly fewer major cardiac and cerebrovascular events (hazard ratio=0.62; 95% confidence interval=0.42-0.91; P=0.014), a trend toward lower all-cause mortality (hazard ratio=0.66; 95% confidence interval=0.38-1.14; P=0.135), and nonworsening liver outcome (hazard ratio=0.66; 95% confidence interval=0.38-1.14; P=0.354). Conclusions In patients with cirrhosis and acute myocardial infarction, selecting a β-blocker is a clinical dilemma. Our study showed that the use of β-selective blockers is associated with lower risks of major cardiac and cerebrovascular events.
在肝硬化合并急性心肌梗死患者中，β-选择性或非选择性β-受体阻滞剂的使用尚不明确。
从台湾 NHIRD（国家健康保险研究数据库）中检索 2001-2013 年的病历记录。排除年龄＜20 岁、既往急性心肌梗死、β-受体阻滞剂禁忌证、慢性阻塞性肺疾病、哮喘或房室传导疾病患者。排除索引住院期间死亡、随访＜6 个月、β-选择性或非选择性β-受体阻滞剂用药比例＜80%或在β-受体阻滞剂之间转换的患者。对使用β-选择性阻滞剂和非选择性β-受体阻滞剂的患者进行倾向评分匹配，并比较结局。主要结局为 1 年和 2 年心血管事件、肝脏不良结局和全因死亡率。共纳入 203595 例急性心肌梗死患者，其中 6355 例合并肝硬化。排除排除标准后，筛选出 1769 例（β-受体阻滞剂组 655 例，未用β-受体阻滞剂组 1114 例）符合条件进行分析。在使用β-受体阻滞剂的患者中，进行倾向评分匹配，选择 218 例使用β-选择性阻滞剂和 218 例使用非选择性β-受体阻滞剂的患者进行研究。在 2 年随访期间，使用β-选择性阻滞剂的患者主要心脑血管事件明显减少（风险比=0.62；95%置信区间=0.42-0.91；P=0.014），全因死亡率呈下降趋势（风险比=0.66；95%置信区间=0.38-1.14；P=0.135），肝脏结局无恶化（风险比=0.66；95%置信区间=0.38-1.14；P=0.354）。
在肝硬化合并急性心肌梗死患者中，选择β-受体阻滞剂是一个临床难题。本研究表明，使用β-选择性阻滞剂与较低的主要心脑血管事件风险相关。
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