Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, China.
Department of Cardiovascular Medicine, The First Branch of the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
BMC Cardiovasc Disord. 2022 Apr 26;22(1):193. doi: 10.1186/s12872-022-02631-8.
The role of beta-blockers in acute myocardial infarction patients without heart failure and with preserved left ventricular ejection fraction (LVEF ≥ 50%) is unknown. Our study aimed to retrospectively analyze the associations of beta-blockers on such patients.
This is a multicenter, retrospective study. After screening 5,332 acute myocardial infarction patients, a total of 2519 patients without heart failure and with LVEF ≥ 50% were included. The patients were divided into two groups: the prescribed (n = 2049) and unprescribed (n = 470) beta-blockers group. The propensity score inverse probability treatment weighting was used to control confounding factors. We analyzed the associations between beta-blockers and outcomes in the short-term (1-year) and long-term (median, 3.61 years).
The primary outcome was all-cause mortality. The secondary outcomes were all-cause rehospitalization, cardiac death, recurrent myocardial infarction, new-onset heart failure rehospitalization. This study shows no statistically significant association between discharged with beta-blockers and all-cause mortality, either in the short-term [IPTW Adjusted, HR 1.02; 95%CI 0.43-2.40; P = 0.966] or long-term [IPTW Adjusted, HR 1.17; 95%CI 0.70-1.94; P = 0.547]. Discharged with beta-blockers was significantly associated with a reduced risk of short-term recurrent myocardial infarction [IPTW Adjusted, HR 0.44; 95%CI 0.20-0.97; P = 0.043], but there was no long-term relationship [IPTW Adjusted, HR 1.11; 95%CI 0.61-2.03; P = 0.735]. Other outcomes, such as new-onset heart failure rehospitalization and all-cause rehospitalization, were not observed with meaningful differences in either the short- or long-term. The results of sensitivity analysis were consistent with this.
Beta-blockers might be associated with a reduced risk of recurrent myocardial infarction in patients without heart failure and with preserved left ventricular ejection fraction after acute myocardial infarction, in the short term. Beta-blockers might not be related to all-cause mortality in those patients, either in the short-term or long-term. Clinical trial registration Influence of Beta-blockers on Prognosis in Patients with Acute Myocardial Infarction Complicated with Normal Ejection Fraction, NCT04485988, Registered on 24/07/2020. Retrospectively registered.
β受体阻滞剂在无心力衰竭且左心室射血分数（LVEF≥50%）保留的急性心肌梗死患者中的作用尚不清楚。本研究旨在回顾性分析β受体阻滞剂对这类患者的影响。
这是一项多中心回顾性研究。在筛选了 5332 例急性心肌梗死患者后，共纳入 2519 例无心力衰竭且 LVEF≥50%的患者。患者被分为两组：已使用（n=2049）和未使用（n=470）β受体阻滞剂组。采用倾向评分逆概率治疗加权法控制混杂因素。我们分析了β受体阻滞剂与短期（1 年）和长期（中位数 3.61 年）结局之间的关系。
主要结局是全因死亡率。次要结局是全因再住院、心脏死亡、复发性心肌梗死、新发心力衰竭再住院。本研究显示，在短期[IPTW 调整后，HR 1.02；95%CI 0.43-2.40；P=0.966]和长期[IPTW 调整后，HR 1.17；95%CI 0.70-1.94；P=0.547]中，出院时使用β受体阻滞剂与全因死亡率均无统计学显著关联。出院时使用β受体阻滞剂与短期复发性心肌梗死风险降低显著相关[IPTW 调整后，HR 0.44；95%CI 0.20-0.97；P=0.043]，但无长期相关性[IPTW 调整后，HR 1.11；95%CI 0.61-2.03；P=0.735]。其他结局，如新发心力衰竭再住院和全因再住院，在短期或长期均未观察到有意义的差异。敏感性分析的结果与此一致。
β受体阻滞剂可能与急性心肌梗死后无心力衰竭且左心室射血分数保留的患者短期复发性心肌梗死风险降低相关。β受体阻滞剂与这些患者的全因死亡率无关，无论是短期还是长期。
临床试验注册 影响β受体阻滞剂在急性心肌梗死合并射血分数正常患者预后中的作用，NCT04485988，2020 年 7 月 24 日注册。回顾性注册。
