Wang Miao, Liu Jing, Liu Jun, Hao Yongchen, Yang Na, Liu Tong, Smith Sidney C, Huo Yong, Fonarow Gregg C, Ge Junbo, Morgan Louise, Ma Changsheng, Han Yaling, Zhao Dong, Zhan Siyan
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2022 Apr 15;9:828614. doi: 10.3389/fcvm.2022.828614. eCollection 2022.
There are limited data available on the impact of early (within 24 h of admission) β-blocker therapy on in-hospital outcomes of patients with ST-elevation myocardial infarction (STEMI) and mild-moderate acute heart failure. This study aimed to explore the association between early oral β-blocker therapy and in-hospital outcomes.
Inpatients with STEMI and Killip class II or III heart failure from the Improving Care for Cardiovascular Disease in China project ( = 10,239) were enrolled. The primary outcome was a combined endpoint composed of in-hospital all-cause mortality, successful cardiopulmonary resuscitation after cardiac arrest, and cardiogenic shock. Inverse-probability-of-treatment weighting, multivariate Cox regression, and propensity score matching were performed.
Early oral β-blocker therapy was administered to 56.5% of patients. The incidence of the combined endpoint events was significantly lower in patients with early therapy than in those without (2.7 vs. 5.1%, < 0.001). Inverse-probability-of-treatment weighting analysis demonstrated that early β-blocker therapy was associated with a low risk of combined endpoint events (HR = 0.641, 95% CI: 0.486-0.844, = 0.002). Similar results were shown in multivariate Cox regression (HR = 0.665, 95% CI: 0.496-0.894, = 0.007) and propensity score matching (HR = 0.633, 95% CI: 0.453-0.884, = 0.007) analyses. A dose-response trend between the first-day β-blocker dosages and adverse outcomes was observed in a subset of participants with available data. No factor could modify the association of early treatment and the primary outcomes among the subgroups analyses.
Based on nationwide Chinese data, early oral β-blocker therapy is independently associated with a lower risk of poor in-hospital outcome in patients with STEMI and Killip class II or III heart failure.
关于早期（入院24小时内）β受体阻滞剂治疗对ST段抬高型心肌梗死（STEMI）合并轻中度急性心力衰竭患者院内结局的影响，现有数据有限。本研究旨在探讨早期口服β受体阻滞剂治疗与院内结局之间的关联。
纳入中国改善心血管疾病护理项目中的STEMI且Killip分级为II级或III级心力衰竭的住院患者（n = 10239）。主要结局是一个复合终点，包括院内全因死亡率、心脏骤停后成功的心肺复苏以及心源性休克。进行了治疗概率逆加权、多因素Cox回归和倾向评分匹配。
56.5%的患者接受了早期口服β受体阻滞剂治疗。早期治疗患者的复合终点事件发生率显著低于未接受早期治疗的患者（2.7%对5.1%，P < 0.001）。治疗概率逆加权分析表明，早期β受体阻滞剂治疗与复合终点事件的低风险相关（HR = 0.641，95%CI：0.486 - 0.844，P = 0.002）。多因素Cox回归（HR = 0.665，95%CI：0.496 - 0.894，P = 0.007）和倾向评分匹配（HR = 0.633，95%CI：0.453 - 0.884，P = 0.007）分析也显示了类似结果。在有可用数据的部分参与者中，观察到首日β受体阻滞剂剂量与不良结局之间存在剂量反应趋势。在亚组分析中，没有因素能够改变早期治疗与主要结局之间的关联。
基于中国全国性数据，早期口服β受体阻滞剂治疗与STEMI合并Killip分级为II级或III级心力衰竭患者院内不良结局风险较低独立相关。
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