Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China.
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Eur Geriatr Med. 2024 Feb;15(1):169-178. doi: 10.1007/s41999-023-00899-3. Epub 2023 Dec 16.
It is uncertain whether β-blockers are beneficial for long-term prognosis in older patients following acute myocardial infarction (AMI). Thus, this study sought to examine the effect of β-blockers on long-term cardiovascular mortality (CVM) in the oldest old (≥ 80 years) with AMI.
In this prospective, consecutive, non-randomized study, a total of 1156 patients with AMI admitted within 24 h after onset of symptoms were enrolled from January 2012 to February 2020. Univariate and multivariate Cox regression analyses were performed to examine the impact of β-blocker use on prognosis. Furthermore, one-to-one propensity score matching (PSM) and inverse probability treatment weighting (IPTW) analyses were used to control for systemic differences between groups. The primary outcome was long-term CVM.
Among the enrolled subjects, 972 (85.9%) were prescribed with β-blockers at discharge. Over a mean follow-up of 26.3 months, 224 cardiovascular deaths were recorded. Both univariate [hazard ratio (HR), 1.41, 95% confidence interval (CI) 0.93-2.13] and multivariate (HR, 1.29, 95% CI 0.79-2.10) Cox regression analyses showed that β-blocker use had no significant association with the long-term CVM, which was further demonstrated by PSM (HR, 1.31, 95% CI 0.75-2.28) and IPTW (HR, 1.41, 95% CI 0.73-2.69) analyses. Subgroup analyses according to sex, heart rate, hypertension, diabetes, revascularization, left ventricular ejection fraction, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers use showed consistent results as well.
Our findings first suggested that the use of β-blockers at discharge in oldest old with AMI was not useful for reducing post-discharge CVM, which need to be further verified by randomized controlled trials.
β受体阻滞剂是否有益于急性心肌梗死（AMI）后老年患者的长期预后尚不确定。因此，本研究旨在探讨β受体阻滞剂对 AMI 中最年长（≥80 岁）患者长期心血管死亡率（CVM）的影响。
在这项前瞻性、连续、非随机研究中，共纳入了 2012 年 1 月至 2020 年 2 月发病后 24 小时内入院的 1156 例 AMI 患者。采用单因素和多因素 Cox 回归分析来检验β受体阻滞剂使用对预后的影响。此外，还进行了 1:1 倾向评分匹配（PSM）和逆概率治疗加权（IPTW）分析，以控制组间的系统性差异。主要结局是长期 CVM。
在纳入的研究对象中，972 例（85.9%）出院时被开了β受体阻滞剂。在平均 26.3 个月的随访期间，有 224 例心血管死亡。单因素[风险比（HR），1.41，95%置信区间（CI）0.93-2.13]和多因素（HR，1.29，95%CI 0.79-2.10）Cox 回归分析均显示，β受体阻滞剂的使用与长期 CVM 无显著相关性，PSM（HR，1.31，95%CI 0.75-2.28）和 IPTW（HR，1.41，95%CI 0.73-2.69）分析也进一步证实了这一点。根据性别、心率、高血压、糖尿病、血运重建、左心室射血分数和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂使用进行的亚组分析也得出了一致的结果。
我们的研究结果首次表明，在 AMI 最年长患者出院时使用β受体阻滞剂并不能降低出院后 CVM，这需要通过随机对照试验进一步验证。
