Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea.
Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea.
Eur Heart J Cardiovasc Pharmacother. 2021 Nov 3;7(6):475-482. doi: 10.1093/ehjcvp/pvaa029.
This observational study aimed to investigate the association between beta-blocker therapy and clinical outcomes in patients with acute myocardial infarction (AMI), especially with mid-range or preserved left ventricular systolic function.
Among 13 624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), 12 200 in-hospital survivors were selected. Patients with beta-blockers showed significantly lower 1-year major adverse cardiac events (MACE), which was a composite of cardiac death, MI, revascularization, and readmission due to heart failure [9.7 vs. 14.3/100 patient-year; hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.72-0.97; P = 0.022). However, this association had a significant interaction with left ventricular ejection fraction (LVEF). Beta-blocker therapy at discharge was associated with lower 1-year MACE in patients with LVEF ≤40% (HR 0.63, 95% CI 0.48-0.81; P < 0.001), and 40% <LVEF < 50% (HR 0.69, 95% CI 0.51-0.94; P = 0.020), but not in patients with LVEF ≥50% (HR 1.16, 95% CI 0.91-1.48; P = 0.234).
Beta-blocker therapy at discharge was associated with better 1-year clinical outcomes in patients with reduced or mid-range LVEF after AMI, but not in patients with preserved LVEF. These data suggested that the long-term beta-blocker therapy may be guided by LVEF.
本观察性研究旨在探讨β受体阻滞剂治疗与急性心肌梗死（AMI）患者临床结局的关系，特别是与左心室射血分数（LVEF）中值或保留的患者。
在韩国急性心肌梗死注册-国立卫生研究院（KAMIR-NIH）纳入的 13624 例患者中，选择了 12200 例住院存活患者。使用β受体阻滞剂的患者 1 年主要不良心脏事件（MACE）显著降低，MACE 包括心脏死亡、心肌梗死、血运重建和因心力衰竭再住院[9.7 比 14.3/100 患者年；风险比（HR）0.84，95%置信区间（CI）0.72-0.97；P=0.022]。然而，这种相关性与 LVEF 有显著的交互作用。出院时使用β受体阻滞剂与 LVEF≤40%的患者 1 年 MACE 降低相关（HR 0.63，95%CI 0.48-0.81；P<0.001），以及 LVEF 40%<LVEF<50%的患者（HR 0.69，95%CI 0.51-0.94；P=0.020），但在 LVEF≥50%的患者中无相关性（HR 1.16，95%CI 0.91-1.48；P=0.234）。
AMI 后 LVEF 降低或中值的患者出院时使用β受体阻滞剂与 1 年临床结局改善相关，但 LVEF 保留的患者无相关性。这些数据表明，长期β受体阻滞剂治疗可能需要根据 LVEF 来指导。
