Liu J, Liu J, Hao Y C, Yang N, Zhou M G, Zeng Y Y, Zhao D
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Sep 24;49(9):886-893. doi: 10.3760/cma.j.cn112148-20201118-00917.
To analyze the status of early use of oral β-blocker and its relationship with in-hospital outcomes in eligible patients with acute coronary syndrome (ACS). The study was based on the Improving Care for Cardiovascular Disease in China (CCC)-ACS project. The data of ACS patients that collected during 2014 to 2019 from 230 collaborating hospitals across China were analyzed. Propensity score matching method and Cox multivariate regression analysis were used to analyze the association between early use of oral β-blocker and in-hospital outcomes within 15 days. A total of 38 663 eligible ACS patients were included in this study. The mean age was (57.0±9.0), and 78.8% of the ACS patients (30 470/38 663) were male. The proportion of early use of oral β-blockers was 64.9% (25 112/38 663), but varied substantially, in the 230 hospitals with a range from 0 to 100%. Compared with the patients no early use of oral β-blocker, the patients receiving early oral β-blocker had significantly lower incidence of major cardiovascular adverse events (MACEs) (3.4% (395/11 536) vs. 2.9%(339/11 536), =0.036)and less occurrences of heart failure (2.7% (316/11 536) vs. 2.1% (248/11 536), =0.004). Multivariate Cox regression analyses showed the patients receiving early oral β-blocker had 15.5%, 23.1%, and 35.3% lower risks of MACEs, heart failure and cardiogenic shock respectively than the patients no early oral β-blocker. Compared with the patients no early oral β-blocker, the patients receiving early oral β-blocker had lower risks of MACEs events, heart failure and cardiogenic shock. However, the early use of oral β-blocker in ACS patients was generally insufficient with huge differences among different hospitals in China.
分析符合条件的急性冠状动脉综合征（ACS）患者早期使用口服β受体阻滞剂的情况及其与住院结局的关系。该研究基于中国心血管疾病医疗质量改善（CCC）-ACS项目。分析了2014年至2019年期间从中国230家合作医院收集的ACS患者数据。采用倾向评分匹配法和Cox多因素回归分析来分析早期使用口服β受体阻滞剂与15天内住院结局之间的关联。本研究共纳入38663例符合条件的ACS患者。平均年龄为（57.0±9.0）岁，78.8%的ACS患者（30470/38663）为男性。口服β受体阻滞剂的早期使用率为64.9%（25112/38663），但在230家医院中差异很大，范围从0到100%。与未早期使用口服β受体阻滞剂的患者相比，早期接受口服β受体阻滞剂的患者主要心血管不良事件（MACE）的发生率显著更低（3.4%（395/11536）对2.9%（339/11536），P=0.036），心力衰竭的发生率也更低（2.7%（316/11536）对2.1%（248/11536），P=0.004）。多因素Cox回归分析显示，与未早期口服β受体阻滞剂的患者相比，早期接受口服β受体阻滞剂的患者发生MACE、心力衰竭和心源性休克的风险分别降低了15.5%、23.1%和35.3%。与未早期口服β受体阻滞剂的患者相比，早期接受口服β受体阻滞剂的患者发生MACE事件、心力衰竭和心源性休克的风险更低。然而，ACS患者早期口服β受体阻滞剂的使用普遍不足，中国不同医院之间存在巨大差异。
