Haim M, Shotan A, Boyko V, Reicher-Reiss H, Benderly M, Goldbourt U, Behar S
The Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Israel.
Am J Cardiol. 1998 Jun 15;81(12):1455-60. doi: 10.1016/s0002-9149(98)00205-7.
The aim of the study was to investigate the effect of beta-blocker treatment on a large cohort of patients with coronary artery disease in functional classes II and III according to the New York Heart Association (NYHA) classification. Among 11,575 patients with coronary artery disease screened for participation, but not included in the Bezafibrate Infarction Prevention (BIP) study, 3,225 (28%) were in NYHA classes II and III. In the latter group of patients we compared the prognosis of 1,109 (34%) treated with beta blockers with 2,116 counterparts not receiving beta-blocker therapy. After a mean follow-up of 4 years, all-cause and cardiac mortality rates were significantly lower among beta-blocker users, 9% and 5%, respectively, than among beta-blocker nonusers, 17% and 11%, respectively (p <0.01 for both). After multivariate adjustment, treatment with beta blockers was associated with a lower all-cause mortality risk (hazards ratio [HR] 0.62, 95% confidence interval [CI] 0.49 to 0.78), and a lower cardiac mortality risk (HR = 0.61, 95% CI 0.45 to 0.83) than was no treatment with a beta blocker. Lower total mortality risk was noted among patients in NYHA class II (HR 0.63, 95% CI 0.48 to 0.82) and in NYHA class III (HR 0.57, 95% CI 0.37 to 0.87) as well as in patients with (HR 0.62, 95% CI 0.48 to 0.81) or without (HR 0.70, 95% CI 0.45 to 1.09) a previous myocardial infarction. We conclude that beta-blocker therapy in coronary patients in NYHA classes II or III is safe and associated with a lower risk for all-cause and cardiac mortality.
本研究的目的是根据纽约心脏协会（NYHA）分级，调查β受体阻滞剂治疗对一大群II级和III级冠心病患者的影响。在11575名接受筛查但未纳入苯扎贝特预防心肌梗死（BIP）研究的冠心病患者中，3225名（28%）属于NYHA II级和III级。在这组患者中，我们比较了1109名（34%）接受β受体阻滞剂治疗的患者与2116名未接受β受体阻滞剂治疗的对照患者的预后。平均随访4年后，β受体阻滞剂使用者的全因死亡率和心脏死亡率分别为9%和5%，显著低于未使用β受体阻滞剂者，分别为17%和11%（两者p均<0.01）。多变量调整后，与未使用β受体阻滞剂治疗相比，使用β受体阻滞剂治疗与较低的全因死亡风险（风险比[HR]0.62，95%置信区间[CI]0.49至0.78）和较低的心脏死亡风险（HR = 0.61，95%CI 0.45至0.83）相关。NYHA II级患者（HR 0.63，95%CI 0.48至0.82）、NYHA III级患者（HR 0.57，95%CI 0.37至0.87）以及有（HR 0.62，95%CI 0.48至0.81）或无（HR 0.70，95%CI 0.45至1.09）既往心肌梗死的患者中，总死亡风险均较低。我们得出结论，NYHA II级或III级冠心病患者使用β受体阻滞剂治疗是安全的，且与较低的全因和心脏死亡风险相关。
