Pagnesi Matteo, Riccardi Mauro, Sacco Alice, Tavecchia Giovanni, Viola Giovanna, Frea Simone, Briani Martina, Bertoldi Letizia Fausta, Bertaina Maurizio, Potena Luciano, Valente Serafina, Marini Marco, De Ferrari Gaetano Maria, D'Ettore Nicoletta, Cardinale Astrid, Camporotondo Rita, Rota Matteo, Tavazzi Guido, Morici Nuccia, Pappalardo Federico, Metra Marco
Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy.
Cardiac Intensive Care Unit, 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
ESC Heart Fail. 2025 Aug;12(4):2565-2577. doi: 10.1002/ehf2.15322. Epub 2025 Jun 9.
We aimed to assess the impact of pre-admission beta-blocker (BB) therapy on the clinical characteristics, in-hospital treatment and outcomes of patients with cardiogenic shock (CS).
All patients enrolled in the multicentre prospective Altshock-2 registry since March 2020 with available data on pre-admission BB therapy were included. Clinical characteristics, in-hospital management, haemodynamic parameters and clinical outcomes were compared in patients with versus without BB therapy. The primary endpoint was in-hospital mortality.
A total of 668 patients were included [median age 66 (56-74) years, male sex 76.5%]: 299 patients (44.8%) with and 369 patients (55.2%) without previous BB therapy. Patients receiving pre-admission BB therapy had more frequently heart failure-related CS (43.8% vs. 17.9%) and less frequently cardiac arrest at presentation (20.1% vs. 27.8%, P = 0.027). Levosimendan was used less frequently and dobutamine was used more frequently in patients with baseline BB therapy (P = 0.033 and P = 0.043, respectively). Differences in the early haemodynamic response to vasoactive drugs were observed between patients with and without previous BB therapy, with a significant impact of baseline BB on mean arterial pressure (MAP) response during norepinephrine infusion (P = 0.012) and with dobutamine having a reduced response in MAP and heart rate in patients receiving BBs before admission (P = 0.023 and P = 0.001, respectively). In-hospital mortality was not significantly different between the BB and no-BB groups (40% vs. 33.7%; adjusted odds ratio 1.32, 95% confidence interval 0.84-2.07, P = 0.224). Similarly, baseline BB therapy was not independently associated with 48 h mortality (12.7% vs. 14.6%; adjusted odds ratio 1.09, 95% confidence interval 0.64-1.87, P = 0.749). The lack of association between baseline BB therapy and mortality was also confirmed at inverse probability of treatment weighting-adjusted analysis.
In a real-world, contemporary cohort of patients with CS, previous BB therapy influenced the haemodynamic response to vasoactive drugs, but it was not associated with in-hospital mortality.
我们旨在评估入院前β受体阻滞剂（BB）治疗对心源性休克（CS）患者临床特征、住院治疗及预后的影响。
纳入自2020年3月起参加多中心前瞻性Altshock-2注册研究且有入院前BB治疗可用数据的所有患者。比较接受BB治疗和未接受BB治疗患者的临床特征、住院管理、血流动力学参数及临床结局。主要终点为住院死亡率。
共纳入668例患者[中位年龄66（56 - 74）岁，男性占76.5%]：299例（44.8%）患者曾接受BB治疗，369例（55.2%）患者未接受过BB治疗。接受入院前BB治疗的患者心力衰竭相关性CS更为常见（43.8%对17.9%），就诊时心脏骤停则较少见（20.1%对27.8%，P = 0.027）。基线接受BB治疗的患者左西孟旦使用较少，多巴酚丁胺使用较多（分别为P = 0.033和P = 0.043）。在接受和未接受过BB治疗的患者之间观察到血管活性药物早期血流动力学反应存在差异，基线BB对去甲肾上腺素输注期间平均动脉压（MAP）反应有显著影响（P = 0.012），且入院前接受BB治疗的患者中多巴酚丁胺对MAP和心率的反应降低（分别为P = 0.023和P = 0.001）。BB组和非BB组的住院死亡率无显著差异（40%对33.7%；调整后的优势比为1.32，95%置信区间为0.84 - 2.07，P = 0.224）。同样，基线BB治疗与48小时死亡率无独立相关性（1日.7%对14.6%；调整后的优势比为1.09，95%置信区间为0.64 - 1.87，P = 0.749）。在治疗权重逆概率调整分析中也证实了基线BB治疗与死亡率之间缺乏相关性。
在一个真实世界的当代CS患者队列中，既往BB治疗影响了对血管活性药物的血流动力学反应，但与住院死亡率无关。
