Research Division, Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, Postbox 635, DK-2900 Copenhagen, Denmark.
Department of Biostatistics, Copenhagen University, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark.
Eur Heart J. 2021 Mar 1;42(9):907-914. doi: 10.1093/eurheartj/ehaa1058.
We aimed to investigate the long-term cardio-protective effect associated with beta-blocker (BB) treatment in stable, optimally treated myocardial infarction (MI) patients without heart failure (HF).
Using nationwide registries, we included patients with first-time MI undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) during admission and treated with both acetyl-salicylic acid and statins post-discharge between 2003 and 2018. Patients with prior history of MI, prior BB use, or any alternative indication or contraindication for BB treatment were excluded. Follow-up began 3 months following discharge in patients alive, free of cardiovascular (CV) events or procedures. Primary outcomes were CV death, recurrent MI, and a composite outcome of CV events. We used adjusted logistic regression and reported standardized absolute risks and differences (ARD) 3 years after MI. Overall, 30 177 stable, optimally treated MI patients were included (58% acute PCI, 26% sub-acute PCI, 16% CAG without intervention). At baseline, 82% of patients were on BB treatment (median age 61 years, 75% male) and 18% were not (median age 62 years, 68% male). BB treatment was associated with a similar risk of CV death, recurrent MI, and the composite outcome of CV events compared with no BB treatment [ARD (95% confidence intervals)] correspondingly; 0.1% (-0.3% to 0.5%), 0.2% (-0.7% to 1.2%), and 1.2% (-0.2% to 2.7%).
In this nationwide cohort study of stable, optimally treated MI patients without HF, we found no long-term effect of BB treatment on CV prognosis following the patients from 3 months to 3 years after MI admission.
我们旨在研究在稳定、最佳治疗的心肌梗死（MI）患者中，β受体阻滞剂（BB）治疗与心力衰竭（HF）无关的长期心脏保护作用。
利用全国性登记处，我们纳入了在 2003 年至 2018 年期间首次因 MI 接受冠状动脉造影（CAG）或经皮冠状动脉介入治疗（PCI）并在出院后接受乙酰水杨酸和他汀类药物治疗的患者，排除了既往有 MI 病史、既往使用 BB 或有 BB 治疗其他适应证或禁忌证的患者。在出院后 3 个月，在无心血管（CV）事件或治疗的存活患者中开始随访。主要结局为 CV 死亡、复发性 MI 和 CV 事件的复合结局。我们使用调整后的逻辑回归，并报告了 MI 后 3 年的标准化绝对风险差异（ARD）。共有 30177 名稳定、最佳治疗的 MI 患者纳入研究（58%急性 PCI，26%亚急性 PCI，16%CAG 无介入）。基线时，82%的患者接受 BB 治疗（中位年龄 61 岁，75%为男性），18%未接受 BB 治疗（中位年龄 62 岁，68%为男性）。与未接受 BB 治疗相比，BB 治疗与 CV 死亡、复发性 MI 和 CV 事件的复合结局风险相似[ARD（95%置信区间）]；分别为 0.1%（-0.3%至 0.5%）、0.2%（-0.7%至 1.2%）和 1.2%（-0.2%至 2.7%）。
在这项针对无 HF 的稳定、最佳治疗的 MI 患者的全国性队列研究中，我们发现 MI 入院后 3 个月至 3 年内，BB 治疗对 CV 预后无长期影响。
