Department of Cardiology, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiovasc Ther. 2020 Apr 24;2020:4351469. doi: 10.1155/2020/4351469. eCollection 2020.
To evaluate the clinical impact of -blocker in patients with adequate left ventricular ejection function (LVEF) who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).
A total of 10,724 consecutive patients who underwent PCI throughout 2013 were prospectively enrolled in the study. Among these, we analyzed 5,631 ACS patients who were discharged with LVEF ≥ 40%. Patients were then compared according to the -blocker prescription at discharge.
During a 2-year follow-up, no significant association was observed of -blocker use with all-cause mortality (with -blockers 47/5,043 (0.9%) without -blocker use 8/588 (1.4%); hazard ratio (HR) 0.762, 95% confidence interval 0.36 to 1.64; = 0.485), cardiac death, myocardial infarction (MI), or major adverse cardiovascular and cerebrovascular events. Subgroup analysis demonstrated that the -blocker use at discharge reduced the 2-year mortality in patients with unstable angina (UA) (HR 0.42, 95% CI 0.19 to 0.94, = 0.034). Landmark analysis at 1 year showed that patients with UA who were discharged with -blockers had lower mortality (HR 0.17, 95% CI 0.04-0.65, = 0.010) and cardiac death (HR 0.12, 95% CI 0.01-0.99, = 0.049) than those discharged without -blockers. However, the benefit was lost beyond 1 year. No differences in outcomes were recorded in the AMI or overall population.
We present that blocker significantly lowers the rate of all-cause death up to 1 year, in UA patients who have undergone PCI and have adequate LVEF. Its role in patients with AMI also deserves further exploration.
评估在接受经皮冠状动脉介入治疗（PCI）治疗急性冠状动脉综合征（ACS）的左心室射血分数（LVEF）正常的患者中，β受体阻滞剂的临床影响。
本研究前瞻性纳入了 2013 年期间接受 PCI 的 10724 例连续患者。在这些患者中，我们分析了 LVEF≥40%出院的 5631 例 ACS 患者。然后根据出院时β受体阻滞剂的处方对患者进行比较。
在 2 年的随访中，β受体阻滞剂的使用与全因死亡率之间无显著相关性（使用β受体阻滞剂的患者 47/5043（0.9%），未使用β受体阻滞剂的患者 8/588（1.4%）；风险比（HR）0.762，95%置信区间 0.36 至 1.64；=0.485）、心脏死亡、心肌梗死（MI）或主要不良心血管和脑血管事件。亚组分析表明，出院时使用β受体阻滞剂可降低不稳定型心绞痛（UA）患者 2 年的死亡率（HR 0.42，95%置信区间 0.19 至 0.94，=0.034）。1 年的里程碑分析显示，出院时使用β受体阻滞剂的 UA 患者死亡率较低（HR 0.17，95%置信区间 0.04 至 0.65，=0.010）和心脏死亡（HR 0.12，95%置信区间 0.01 至 0.99，=0.049），而未使用β受体阻滞剂的患者。然而，这种获益在 1 年以后就消失了。在 AMI 或总体人群中，未观察到结局的差异。
我们的研究表明，在接受 PCI 治疗且 LVEF 正常的 UA 患者中，β受体阻滞剂可显著降低 1 年内全因死亡率。在 AMI 患者中，β受体阻滞剂的作用也值得进一步探索。
