Wang Wen-Hwa, Cheng Chin-Chang, Mar Guang-Yuan, Wei Kai-Che, Huang Wei-Chun, Liu Chun-Peng
Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
I-Shou University, Kaohsiung, Taiwan.
Heart Vessels. 2019 Jul;34(7):1158-1167. doi: 10.1007/s00380-019-01341-0. Epub 2019 Jan 24.
β-Blockers are a standard therapy for acute myocardial infarction (AMI) due to their better short-term and long-term outcomes. However, β-blockers are often under-prescribed in chronic obstructive pulmonary disease (COPD) patients with AMI, since they are thought be related to bronchospasm. The aim of this study was to investigate the association between the usage of β-blockers and the risk of mortality in COPD patients after first AMI via a nationwide, population-based cohort study. In this retrospective study, we identified 186,326 patients with AMI diagnosed between January 2000 and December 2012, 23,116 of whom had COPD, from the National Health Insurance Research Database. A total of 7609 patients (32.92%) were prescribed β-blockers, while 15,507 were not. The β-blocker patients were stratified into selective and non-selective β-blocker groups. Multivariate Cox proportional hazards models were used to estimate adjusted hazard ratios (HR) with 95% confidence intervals (95% CI). Selective β-blocker use showed a reduced risk of mortality, as compared with patients without β-blockers (HR 0.93; 95% CI 0.89-0.98; p < 0.01) while non-selective β-blocker groups did not increase the risk of mortality compared to the patients without β-blockers (HR 0.98; 95% CI 0.94-1.02; p = 0.38). In addition, the use of β-blockers was found to be associated with a reduced risk of mortality in most stratified analyses which was seen particularly in males, patients aged 65 years and above, and in individuals with an array of comorbidities. These findings suggest that β-blockers improve overall survival among COPD patients after first AMI.
β受体阻滞剂是急性心肌梗死（AMI）的标准治疗方法，因其具有较好的短期和长期疗效。然而，β受体阻滞剂在患有AMI的慢性阻塞性肺疾病（COPD）患者中常常未得到充分处方，因为它们被认为与支气管痉挛有关。本研究的目的是通过一项全国性的、基于人群的队列研究，调查β受体阻滞剂的使用与COPD患者首次AMI后死亡风险之间的关联。在这项回顾性研究中，我们从国民健康保险研究数据库中识别出2000年1月至2012年12月期间诊断为AMI的186,326例患者，其中23,116例患有COPD。共有7609例患者（32.92%）被处方使用β受体阻滞剂，而15,507例未使用。使用β受体阻滞剂的患者被分为选择性和非选择性β受体阻滞剂组。采用多变量Cox比例风险模型来估计调整后的风险比（HR）及95%置信区间（95%CI）。与未使用β受体阻滞剂的患者相比，使用选择性β受体阻滞剂显示死亡风险降低（HR 0.93；95%CI 0.89 - 0.98；p < 0.01），而与未使用β受体阻滞剂的患者相比，非选择性β受体阻滞剂组并未增加死亡风险（HR 0.98；95%CI 0.94 - 1.02；p = 0.38）。此外，在大多数分层分析中发现，使用β受体阻滞剂与死亡风险降低相关，这在男性、65岁及以上患者以及患有一系列合并症的个体中尤为明显。这些发现表明β受体阻滞剂可改善COPD患者首次AMI后的总体生存率。
