Won Hoyoun, Suh Yongsung, Kim Gwang Sil, Ko Young Guk, Hong Myeong Ki
Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Cardiology, Myongji Hospital, Goyang, Korea.
Korean Circ J. 2020 Jun;50(6):499-508. doi: 10.4070/kcj.2019.0231. Epub 2020 Jan 6.
Whether beta blockers favorably impact the clinical outcome in patients with acute myocardial infarction (AMI) remains in debate. We investigated the impact of beta blocker on major clinical outcomes during 2 years after percutaneous coronary intervention (PCI) in patients with AMI.
All patients with the first AMI treated with PCI for the period of 2005 to 2014 from the Korean National Health Insurance Service claims database were enrolled. We defined the regular user as medication possession ratio (MPR) ≥80% and non-user as MPR=0%. We compared the occurrence of all cause death, myocardial infarction (MI) and stroke according to adherence of beta-blockers. A 1:1 propensity score-matching was conducted to adjust for between-group differences.
We identified a total 81,752 patients with met eligible criteria. At discharge, 63,885 (78%) patients were prescribed beta blockers. For 2 years follow up period, regular users were 53,991 (66%) patients, non-users were 10,991 (13%). In the propensity score matched population, regular use of beta blocker was associated with a 36% reduced risk of composite adverse events (all death, MI or stroke) (hazard ratio [HR], 0.636; 95% confidence interval [CI], 0.555-0.728; p<0.001). Compared to no use of beta blocker, regular use significantly reduced all death (HR, 0.736; 95% CI, 0.668-0.812; p<0.001), MI (HR, 0.729; 95% CI, 0.611-0.803; p<0.001) and stroke (HR, 0.717; 95% CI, 0.650-0.791; p<0.001).
Prescription of beta blocker in patients with AMI after PCI was sequentially increased. Continuous regular use of beta blocker for 2 years after AMI reduced major adverse events compared to no use of beta blocker.
β受体阻滞剂对急性心肌梗死（AMI）患者临床结局是否产生有利影响仍存在争议。我们调查了β受体阻滞剂对AMI患者经皮冠状动脉介入治疗（PCI）后2年主要临床结局的影响。
纳入2005年至2014年期间韩国国民健康保险服务索赔数据库中所有接受PCI治疗的首次AMI患者。我们将规律使用者定义为药物持有率（MPR）≥80%，非使用者定义为MPR = 0%。我们根据β受体阻滞剂的依从性比较了全因死亡、心肌梗死（MI）和中风的发生率。进行1:1倾向评分匹配以调整组间差异。
我们共确定了81752例符合入选标准的患者。出院时，63885例（78%）患者被处方了β受体阻滞剂。在2年随访期内，规律使用者为53991例（66%），非使用者为10991例（13%）。在倾向评分匹配人群中，规律使用β受体阻滞剂与复合不良事件（全因死亡、MI或中风）风险降低36%相关（风险比[HR]，0.636；95%置信区间[CI]，0.555 - 0.728；p < 0.001）。与未使用β受体阻滞剂相比，规律使用显著降低了全因死亡（HR，0.736；95% CI，0.668 - 0.812；p < 0.001）、MI（HR，0.729；95% CI，0.611 - 0.803；p < 0.001）和中风（HR，0.717；95% CI，0.650 - 0.791；p < 0.001）。
PCI术后AMI患者中β受体阻滞剂的处方量呈递增趋势。与未使用β受体阻滞剂相比，AMI后持续规律使用β受体阻滞剂2年可降低主要不良事件的发生。
