Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan.
Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan.
J Cardiol. 2023 Jan;81(1):83-90. doi: 10.1016/j.jjcc.2022.08.002. Epub 2022 Aug 20.
Beta-blockers are associated with several clinical benefits in patients with reduced left ventricular ejection fraction (REF) after acute myocardial infarction (AMI), such as lower rates of mortality, recurrence of myocardial infarction, and heart failure. However, the long-term prognosis of beta-blockers has rarely been investigated in patients with non-REF after AMI. This study aimed to investigate the clinical benefits of beta-blockers in these patients.
A total of 3281 consecutive patients who were hospitalized within 48 h after AMI were registered in the J-MINUET study. Patients who underwent primary percutaneous coronary intervention (PCI) and had a left ventricular ejection fraction ≥40 % were enrolled, and patients who died during admission were excluded. Included patients were divided into two groups according to the prescription of beta-blockers at discharge. Their characteristics and clinical outcomes were compared.
The number of AMI patients treated with beta-blockers was 1353 (70.4 %). Patients who received beta-blockers were younger and had a higher incidence of hypertension, dyslipidemia, and ST-segment elevation myocardial infarction than those who did not receive beta-blockers. The peak creatine kinase level after primary PCI was significantly higher in patients who received beta-blockers. These patients also had a lower incidence of a composite of all-cause death, myocardial infarction, and stroke compared to those that did not receive beta-blockers (7.3 % vs. 11.9 %, p = 0.001). Multivariate analysis showed that beta-blocker use was an independent factor for better clinical outcomes.
The J-MINUET study revealed the clinical benefit of beta-blockers in AMI patients with non-REF after primary PCI.
β受体阻滞剂在急性心肌梗死（AMI）后左心室射血分数（REF）降低的患者中具有多种临床获益，例如降低死亡率、心肌梗死复发和心力衰竭的发生率。然而，AMI 后非 REF 患者中β受体阻滞剂的长期预后很少被研究。本研究旨在探讨β受体阻滞剂在这些患者中的临床获益。
共纳入 3281 例在 AMI 后 48 小时内住院的连续患者，这些患者均接受了直接经皮冠状动脉介入治疗（PCI），且左心室射血分数≥40%。排除住院期间死亡的患者。根据出院时β受体阻滞剂的处方将纳入患者分为两组，并比较其特征和临床结局。
共 1353 例 AMI 患者接受了β受体阻滞剂治疗（70.4%）。接受β受体阻滞剂治疗的患者比未接受β受体阻滞剂治疗的患者年龄更小，且高血压、血脂异常和 ST 段抬高型心肌梗死的发生率更高。接受β受体阻滞剂治疗的患者首次 PCI 后肌酸激酶峰值显著更高。与未接受β受体阻滞剂治疗的患者相比，这些患者的全因死亡、心肌梗死和卒中的复合发生率更低（7.3%比 11.9%，p=0.001）。多变量分析显示，β受体阻滞剂的使用是临床结局改善的独立因素。
J-MINUET 研究揭示了在接受直接 PCI 的 AMI 后非 REF 患者中β受体阻滞剂的临床获益。
