Boo Ki Yung, Kim Miyeon, Lee Jae-Geun, Ko Geum, Choi Joon Hyouk, Kim Song-Yi, Joo Seung-Jae, Hwang Jin-Yong, Hur Seung-Ho, Cha Kwang Soo, Jeong Myung Ho
Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea.
Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea.
PLoS One. 2025 Jun 23;20(6):e0326516. doi: 10.1371/journal.pone.0326516. eCollection 2025.
Beta-blockers have been considered the cornerstone of treatment for patients with acute myocardial infarction (AMI). However, long-term benefits of vasodilating beta-blockers remain uncertain. This study aimed to investigate the long-term clinical benefits of vasodilating beta-blockers compared to conventional beta-blockers in AMI patients with mildly reduced ejection fraction (mrEF). Among 13,624 patients who enrolled in the nationwide AMI database of South Korea, the KAMIR-NIH Registry, 2,662 AMI patients with mrEF, who were prescribed beta-blockers at discharge were selected for this study. The primary outcome was a composite of cardiac death, recurrent MI, or hospitalization for heart failure (HF) during 3-year follow up period. In the entire cohort, the use of vasodilating beta-blockers at discharge was associated with lower incidence of primary outcome at 3-year (hazard ratio [HR] 0.80; 95% confidence interval [CI], 0.62-0.98; P = 0.039) compared to the use of conventional beta-blockers at discharge. In the propensity score-matched (PSM) cohort, the use of vasodilating beta-blockers at discharge was also associated with a significantly lower incidence of primary outcome (HR, 0.66; 95% CI, 0.50-0.88; P = 0.004) compared to the use of conventional beta-blockers at discharge. Furthermore, in the PSM cohort, the use of vasodilating beta-blockers was associated with lower incidences of the cardiac death (HR, 0.60; 95% CI, 0.39-0.92; P = 0.020), hospitalization for HF (HR, 0.72; 95% CI, 0.46-0.98; P = 0.042), and all-cause death (HR, 0.67; 95% CI, 0.48-0.93; P = 0.017) compared to the use of conventional beta-blockers. However, no significant differences were observed between the groups in the incidences of recurrent MI (HR, 0.62; 95% CI, 0.34-1.14; P = 0.122), any revascularization (HR, 1.04; 95% CI, 0.76-1.42; P = 0.821), stroke (HR, 0.84; 95% CI, 0.44-1.60; P = 0.589), stent thrombosis (HR, 1.12; 95% CI, 0.40-3.11; P = 0.833). In AMI patients with mrEF, the use of vasodilating beta-blockers at discharge was associated with better long-term clinical outcomes compared to the use of conventional beta-blockers.
β受体阻滞剂一直被视为急性心肌梗死（AMI）患者治疗的基石。然而，血管舒张性β受体阻滞剂的长期益处仍不确定。本研究旨在探讨与传统β受体阻滞剂相比，血管舒张性β受体阻滞剂对射血分数轻度降低（mrEF）的AMI患者的长期临床益处。在纳入韩国全国AMI数据库KAMIR-NIH注册研究的13624例患者中，选取2662例mrEF且出院时开具β受体阻滞剂的AMI患者进行本研究。主要结局是3年随访期内心脏性死亡、复发性心肌梗死或因心力衰竭（HF）住院的复合结局。在整个队列中，与出院时使用传统β受体阻滞剂相比，出院时使用血管舒张性β受体阻滞剂在3年时主要结局的发生率更低（风险比[HR]0.80；95%置信区间[CI]，0.62 - 0.98；P = 0.039）。在倾向评分匹配（PSM）队列中，与出院时使用传统β受体阻滞剂相比，出院时使用血管舒张性β受体阻滞剂主要结局的发生率也显著更低（HR，0.66；95%CI，0.50 - 0.88；P = 0.004）。此外，在PSM队列中，与使用传统β受体阻滞剂相比，使用血管舒张性β受体阻滞剂的心源性死亡（HR，0.60；95%CI，0.39 - 0.92；P = 0.020）、HF住院（HR，0.72；95%CI，0.46 - 0.98；P = 0.042）和全因死亡（HR，0.67；95%CI，0.48 - 0.93；P = 0.017）的发生率更低。然而，两组在复发性心肌梗死（HR，0.62；95%CI，0.34 - 1.14；P = 0.122）、任何血管重建（HR，1.04；95%CI，0.76 - 1.42；P = 0.821）、中风（HR，0.84；95%CI，0.44 - 1.60；P = 0.589）、支架血栓形成（HR，1.12；95%CI，0.40 - 3.11；P = 0.833）的发生率上未观察到显著差异。在mrEF的AMI患者中，与使用传统β受体阻滞剂相比，出院时使用血管舒张性β受体阻滞剂与更好的长期临床结局相关。
