Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Division of Cardiology, Orlando Health Heart Institute, Orlando, Florida.
Am J Cardiol. 2023 Jul 1;198:124-132. doi: 10.1016/j.amjcard.2023.04.022. Epub 2023 May 12.
Beta blockers are uniformly recommended for all patients after myocardial infarction (MI), including those with diabetes mellitus (DM). This study assesses the impact of β-blocker type and dosing on survival in patients with DM after MI. A cohort of 6,682 patients in the Outcomes of Beta-blocker Therapy After Myocardial INfarction registry were discharged after MI. In this cohort, 2,137 patients had DM (32%). Beta-blocker dose was indexed to the target daily dose used in randomized clinical trials and reported as percentage. Dosage groups were: no β blocker, >0% to 12.5%, >12.5% to 25%, >25% to 50%, and >50% of the target dose. The overall mean discharge β-blocker dose in patients with DM was 42.7 ± 34.1% versus 35.9 ± 27.4% in patients without DM (p <0.0001). Patients with DM were prescribed carvedilol at a higher rate than those without DM (27.8% vs 19.6%). The 3-year mortality estimates were 24.4% and 12.8% for patients with DM versus without DM (p <0.0001), respectively, with an unadjusted hazard ratio = 1.820 (confidence interval 1.587 to 2.086, p <0.0001). Patients with DM in the >12.5% to 25% dose category had the highest survival rates, whereas patients in the >50% dose had the lowest survival rate among patients discharged on β blockers (p <0.0001). In the multivariable analysis among patients with DM after MI, all β-blocker dose categories demonstrated lower mortality than no therapy; however, only the >12.5% to 25% dose had a statistically significant hazard ratio 0.450 (95% confidence interval 0.224 to 0.907, p = 0.025). In patients with DM, there was no statistically significant difference in 3-year mortality among those treated with metoprolol versus carvedilol. In conclusion, our analysis in patients with DM after MI suggested a survival benefit from β-blocker therapy, with no apparent advantage to high- versus low-dose β-blocker therapy; although, physicians tended to prescribe higher doses in patients with DM. There was no survival benefit for carvedilol over metoprolol in patients with DM.
β受体阻滞剂被一致推荐用于所有心肌梗死后（MI）的患者，包括合并糖尿病（DM）的患者。本研究评估了β受体阻滞剂类型和剂量对 MI 后合并 DM 患者生存的影响。在 Outcomes of Beta-blocker Therapy After Myocardial INfarction 登记研究中，有 6682 名患者出院时患有 MI。在该队列中，有 2137 名患者患有 DM（32%）。β受体阻滞剂的剂量以随机临床试验中使用的目标日剂量为指标，并以百分比表示。剂量组为：无β受体阻滞剂、>0%至 12.5%、>12.5%至 25%、>25%至 50%和>50%目标剂量。在合并 DM 的患者中，出院时β受体阻滞剂的平均剂量为 42.7±34.1%，而在无 DM 的患者中为 35.9±27.4%（p<0.0001）。与无 DM 患者相比，DM 患者更倾向于使用卡维地洛（27.8% vs 19.6%）。DM 患者的 3 年死亡率估计分别为 24.4%和 12.8%（p<0.0001），未经调整的风险比为 1.820（95%置信区间为 1.587 至 2.086，p<0.0001）。在β受体阻滞剂治疗的患者中，>12.5%至 25%剂量组的患者生存率最高，而>50%剂量组的患者生存率最低（p<0.0001）。在 MI 后合并 DM 的患者的多变量分析中，所有β受体阻滞剂剂量组的死亡率均低于无治疗组；然而，只有>12.5%至 25%剂量组的风险比具有统计学意义（0.450，95%置信区间 0.224 至 0.907，p=0.025）。在合并 DM 的患者中，接受美托洛尔和卡维地洛治疗的患者在 3 年死亡率方面无统计学差异。总之，我们对 MI 后合并 DM 的患者进行的分析表明，β受体阻滞剂治疗具有生存获益，高剂量与低剂量β受体阻滞剂治疗之间无明显差异；尽管如此，医生倾向于为 DM 患者开更高剂量的药物。在合并 DM 的患者中，卡维地洛并未比美托洛尔有生存获益。
