Department of Cardiology. Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.
Department of Cardiology. Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain; Universidad Complutense, Madrid, Spain.
Rev Port Cardiol (Engl Ed). 2021 Apr;40(4):285-290. doi: 10.1016/j.repc.2020.07.017. Epub 2021 Feb 26.
Beta-blockers are recommended after ST-elevation myocardial infarction (STEMI), but their benefit in patients with preserved left ventricular ejection fraction (LVEF) is unclear.
Consecutive patients discharged in sinus rhythm after STEMI between January 2010 and April 2015 were followed until December 2017. Percutaneous coronary intervention (PCI) was performed in 969 (99.7%, including 112 with rescue PCI) and three (0.3%) received only thrombolytic therapy without rescue PCI.
Of these 972 patients, mean age 62.6±13.5 years, 212 (21.8%) were women and 835 (85.9%) were prescribed beta-blockers at discharge. Patients who did not receive beta-blockers had more comorbidities than those who did, including chronic obstructive pulmonary disease (14.6% vs. 4.2%), anemia (8.0% vs. 3.7%), and cancer (7.3% vs. 2.8%), and more frequently had inferior STEMI (75.9% vs. 56.0%) and high-grade atrioventricular block (13.1% vs. 5.3%) (all p<0.01). After a mean follow-up of 49.6±24.9 months, beta-blocker treatment at discharge was independently associated with lower mortality (HR 0.61, 95% confidence interval [CI] 0.38-0.96, p=0.03). This effect was present in 192 patients with LVEF ≤40% (HR 0.57, 95% 95% CI 0.34-0.97, p=0.04) but was not clear in 643 patients with LVEF >40% (HR 0.67, 95% 95% CI 0.25-1.76, p=0.42).
In the LVEF >40% group, the results raise reasonable doubts about the real benefit of systematic use of beta-blockers as treatment for these patients. These findings reinforce the need for large randomized clinical trials within this group of patients.
ST 段抬高型心肌梗死（STEMI）后推荐使用β受体阻滞剂，但对于左心室射血分数（LVEF）保留的患者，其获益尚不明确。
连续纳入 2010 年 1 月至 2015 年 4 月期间窦性心律出院的 STEMI 患者，随访至 2017 年 12 月。969 例（99.7%，包括 112 例补救性 PCI）患者接受经皮冠状动脉介入治疗（PCI），3 例（0.3%）仅接受溶栓治疗而未行补救性 PCI。
972 例患者中，平均年龄 62.6±13.5 岁，212 例（21.8%）为女性，835 例（85.9%）出院时开具β受体阻滞剂。未使用β受体阻滞剂的患者比使用的患者合并症更多，包括慢性阻塞性肺疾病（14.6%比 4.2%）、贫血（8.0%比 3.7%）和癌症（7.3%比 2.8%），且更常发生下壁 STEMI（75.9%比 56.0%）和高级别房室传导阻滞（13.1%比 5.3%）（均 P<0.01）。平均随访 49.6±24.9 个月后，出院时使用β受体阻滞剂与较低的死亡率相关（HR 0.61，95%CI 0.38-0.96，P=0.03）。这一效果在 192 例 LVEF≤40%的患者中存在（HR 0.57，95%CI 0.34-0.97，P=0.04），但在 643 例 LVEF>40%的患者中不明显（HR 0.67，95%CI 0.25-1.76，P=0.42）。
在 LVEF>40%的患者中，结果对系统使用β受体阻滞剂作为此类患者治疗的真正获益提出了合理的质疑。这些发现强调了需要在这组患者中进行大型随机临床试验。
