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Hu M, Lang X, Yang J, Wang Y, Li W, Gao X, Yang Y. The prevalence and outcomes in STEMI patients aged ≥75 undergoing primary percutaneous coronary intervention in China. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200251. [PMID: 38464698 PMCID: PMC10921244 DOI: 10.1016/j.ijcrp.2024.200251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
Objective To investigate the prevalence and outcomes of primary percutaneous coronary intervention (PCI) in Chinese patients with ST-segment elevation myocardial infarction (STEMI) aged ≥75 years. Methods We identified STEMI patients aged ≥75 years between 2013 and 2014 from a multicenter registry. The primary outcome was all-cause mortality. The secondary outcome was major adverse cardiac and cerebrovascular event (MACCE) including a composite of all-cause mortality, cardiac death, recurrent MI, stroke, revascularization, and major bleeding. Hazard ratios (HR) and associated 95% confidence interval (CI) were calculated. Results Approximately 32.9% (n = 999) patients received primary PCI. Primary PCI was associated with lower risks of two-year all-cause mortality (18.0% vs. 36.4%; adjusted HR: 0.54, 95% CI: 0.45 to 0.65, P < 0.0001), MACCE (28.7% vs. 43.5%; adjusted HR: 0.68, 95% CI: 0.59 to 0.80, P < 0.0001), and cardiac death (10.0% vs. 23.6%; adjusted HR: 0.49, 95% CI: 0.38 to 0.62, P < 0.0001) relative to no reperfusion (n = 2041) in patients aged ≥75 years. The better outcomes in two-year all-cause mortality, MACCE, and cardiac death were consistently observed in STEMI patients aged ≥85 years. No differences were observed in recurrent MI, stroke, revascularization, and major bleeding between the two groups. Additionally, in patients with relatively high-risk profiles such as cardiogenic shock or delaying hospital admission, primary PCI was also superior to no reperfusion. Conclusion Primary PCI may decrease two-year all-cause mortality, MACCE, and cardiac death in STEMI patients aged ≥75 years, even in these with age ≥85 years, cardiogenic shock, or delaying hospital admission. However, primary PCI was underutilized in Chinese clinical practice.
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Affiliation(s)
- Mengjin Hu
- Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xinyue Lang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Jingang Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Xiaojin Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - for the China Acute Myocardial Infarction Registry Investigators
- Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
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Joo SJ. Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it. Acute Crit Care 2023; 38:251-260. [PMID: 37652855 PMCID: PMC10497890 DOI: 10.4266/acc.2023.00955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
Most of the evidences for beneficial effects of beta-blockers in patients with acute myocardial infarction (AMI) were from the clinical studies published in the pre-reperfusion era when anti-platelet drugs, statins or inhibitors of renin-angiotensin-aldosterone system which are known to reduce cardiovascular mortality of patients with AMI were not introduced. In the reperfusion era, beta-blockers' benefit has not been clearly shown except in patients with reduced ejection fraction (EF; ≤40%). In the era of the early reperfusion therapy for AMI, a number of patients with mildly reduced EF (>40%, <50%) or preserved EF (≥50%) become increasing. However, because no randomized clinical trials are available until now, the benefit and the optimal duration of oral treatment with beta-blockers in patients with mildly reduced or preserved EF are questionable. Registry data have not showed the association of oral beta-blocker therapy with decreased mortality in survivors without heart failure or left ventricular systolic dysfunction after AMI. In the Korea Acute Myocardial Infarction Registry-National Institute of Health of in-hospital survivors after AMI, the benefit of beta-blocker therapy at discharge was shown in patients with reduced or mildly reduced EF, but not in those with preserved EF, which provides new information about beta-blocker therapy in patients without reduced EF. However, clinical practice can be changed when the results of appropriate randomized clinical trials are available. Ongoing clinical trials may help to answer the unresolved issues of beta-blocker therapy in patients with AMI.
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Affiliation(s)
- Seung-Jae Joo
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
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Lee M, Lee K, Kim D, Cho JS, Kim T, Kwon J, Kim CJ, Park CS, Kim HY, Yoo K, Jeon DS, Chang K, Kim MC, Jeong MH, Ahn Y, Park M. Comparative Effectiveness of Long-Term Maintenance Beta-Blocker Therapy After Acute Myocardial Infarction in Stable, Optimally Treated Patients Undergoing Percutaneous Coronary Intervention. J Am Heart Assoc 2023; 12:e028976. [PMID: 37493020 PMCID: PMC10492964 DOI: 10.1161/jaha.122.028976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/03/2023] [Indexed: 07/27/2023]
Abstract
Background The benefits of long-term maintenance beta-blocker (BB) therapy in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) have not been well established. Methods and Results Using the Korean nationwide registry, a total of 7159 patients with AMI treated with PCI who received BBs at discharge and were free from death or cardiovascular events for 3 months after PCI were included in the analysis. Patients were divided into 4 groups according to BB maintenance duration: <12 months, 12 to <24 months, 24 to <36 months, and ≥36 months. The primary outcome was the composite of all-cause death, recurrent MI, heart failure, or hospitalization for unstable angina. During a mean 5.0±2.8 years of follow-up, over half of patients with AMI (52.5%) continued BB therapy beyond 3 years following PCI. After propensity score matching and propensity score marginal mean weighting through stratification, a stepwise inverse correlation was noted between BB duration and risk of the primary outcome (<12 months: hazard ratio [HR], 2.19 [95% CI, 1.95-2.46]; 12 to <24 months: HR, 2.10 [95% CI, 1.81-2.43];, and 24 to <36 months: HR, 1.68 [95%CI, 1.45-1.94]; reference: ≥36 months). In a 3-year landmark analysis, BB use for <36 months was associated with an increased risk of the primary outcome (adjusted HR, 1.59 [95% CI, 1.37-1.85]) compared with BB use for ≥36 months. Conclusions Among stabilized patients with AMI following PCI, longer maintenance BB therapy, especially for >36 months, was associated with better clinical outcomes. These findings might imply that a better prognosis can be expected if patients with AMI maintain BB therapy for ≥36 months after PCI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02806102.
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Affiliation(s)
- Myunhee Lee
- Division of Cardiology, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
| | - Kyusup Lee
- Division of Cardiology, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
| | - Dae‐Won Kim
- Division of Cardiology, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
| | - Jung Sun Cho
- Division of Cardiology, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
| | - Tae‐Seok Kim
- Division of Cardiology, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
| | - Jongbum Kwon
- Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
| | - Chan Joon Kim
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
| | - Chul Soo Park
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
| | - Hee Yeol Kim
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
| | - Ki‐Dong Yoo
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
| | - Doo Soo Jeon
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
| | - Kiyuk Chang
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
| | - Min Chul Kim
- Cardiovascular CenterChonnam National University Hospital, Chonnam National UniversityGwangjuRepublic of Korea
| | - Myung Ho Jeong
- Cardiovascular CenterChonnam National University Hospital, Chonnam National UniversityGwangjuRepublic of Korea
| | - Youngkeun Ahn
- Cardiovascular CenterChonnam National University Hospital, Chonnam National UniversityGwangjuRepublic of Korea
| | - Mahn‐Won Park
- Division of Cardiology, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
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Kim MH, Yuan SL, Lee KM, Jin X, Song ZY, Cho YR, Lee MS, Kim JH, Jeong MH. Clinical Outcomes of Calcium-Channel Blocker vs Beta-Blocker: From the Korean Acute Myocardial Infarction Registry. JACC. ASIA 2023; 3:446-454. [PMID: 37396422 PMCID: PMC10308128 DOI: 10.1016/j.jacasi.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 07/04/2023]
Abstract
Background Although current guidelines recommend beta-blockers (BBs) after acute myocardial infarction (AMI), the role of calcium-channel blockers (CCBs) has not been well investigated, especially nondihydropyridine. Objectives This study aimed to compare the effects of CCBs on cardiovascular outcomes compared with BBs in AMI because patients from East Asia have a higher incidence of a vasospastic angina component compared with Western countries. Methods Among 15,628 patients enrolled in the KAMIR-V (Korean Acute Myocardial Infarction Registry-V), we evaluated 10,650 in-hospital survivors who were treated with either CCBs or BBs. We applied a propensity score for 1:4 pair matching of baseline covariates and Cox regression to compare CCBs and BBs. The primary endpoint was all-cause death at 1 year. The secondary endpoints were 1-year major adverse cardiac and cerebrovascular events, which was the composite of cardiac death, myocardial infarction, revascularization, and readmission due to heart failure and stroke. Results There was a significant interaction with the treatment arm with left ventricular ejection fraction (LVEF) (P for interaction = 0.011). CCB groups at discharge had higher 1-year cardiac death and major adverse cardiac and cerebrovascular events for patients with LVEF <50% (HR: 4.950; 95% CI: 1.329-18.435; P = 0.017; and HR: 1.810; 95% CI: 1.038-3.158; P = 0.037, respectively) but not for patients with LVEF ≥50% (HR: 0.699; 95% CI: 0.435-1.124; P = 0.140). Conclusions CCB therapy did not increase adverse cardiovascular events for patients after AMI with preserved LVEF. CCBs can be considered as an alternative for BBs in East Asian patients after AMI with preserved LVEF.
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Affiliation(s)
- Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Song Lin Yuan
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Kwang Min Lee
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Xuan Jin
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Zhao Yan Song
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan, Republic of Korea
| | - Michael S. Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, California, USA
| | - Ju Han Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
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Lee K, Han S, Lee M, Kim DW, Kwon J, Park GM, Park MW. Evidence-Based Optimal Medical Therapy and Mortality in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention. J Am Heart Assoc 2023; 12:e024370. [PMID: 37158100 DOI: 10.1161/jaha.121.024370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background The secondary prevention with pharmacologic therapy is essential for preventing recurrent cardiovascular events in patients experiencing acute myocardial infarction. Guideline-based optimal medical therapy (OMT) for patients with acute myocardial infarction consists of antiplatelet therapy, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, β-blockers, and statins. We aimed to determine the prescription rate of OMT use at discharge and to evaluate the impact of OMT on long-term clinical outcomes in patients with acute myocardial infarction who underwent percutaneous coronary intervention in the drug-eluting stent era using nationwide cohort data. Methods and Results Using the National Health Insurance claims data in South Korea, patients with acute myocardial infarction who had undergone percutaneous coronary intervention with a drug-eluting stent between July 2013 and June 2017 were enrolled. A total of 35 972 patients were classified into the OMT and non-OMT groups according to the post-percutaneous coronary intervention discharge medication. The primary end point was all-cause death, and the 2 groups were compared using a propensity-score matching analysis. Fifty-seven percent of patients were prescribed OMT at discharge. During the follow-up period (median, 2.0 years [interquartile range, 1.1-3.2 years]), OMT was associated with a significant reduction in the all-cause mortality (adjusted hazard ratio [aHR], 0.82 [95% CI, 0.76-0.90]; P<0.001) and composite outcome of death or coronary revascularization (aHR, 0.89 [95% CI, 0.85-0.93]; P<0.001). Conclusions OMT was prescribed at suboptimal rates in South Korea. However, our nationwide cohort study showed that OMT has a benefit for long-term clinical outcomes on all-cause mortality and composite outcome of death or coronary revascularization after percutaneous coronary intervention in the drug-eluting stent era.
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Affiliation(s)
- Kyusup Lee
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea
| | - Seungbong Han
- Department of Biostatistics, College of Medicine Korea University Seoul Republic of Korea
| | - Myunhee Lee
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea
| | - Dae-Won Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea
| | - Jongbum Kwon
- Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary's Hospital The Catholic University of Korea Daejeon Republic of Korea
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital University of Ulsan College of Medicine Ulsan Republic of Korea
| | - Mahn-Won Park
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
- Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine The Catholic University of Korea Daejeon Republic of Korea
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Beta-Blocker Use after Discharge in Patients with Acute Myocardial Infarction in the Contemporary Reperfusion Era. Medicina (B Aires) 2022; 58:medicina58091177. [PMID: 36143854 PMCID: PMC9506114 DOI: 10.3390/medicina58091177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objectives: The effect of beta-blocker use after discharge on patients with acute myocardial infarction (AMI) in the contemporary reperfusion era remains ambiguous. By applying meta-analysis, we sought to assess the role of beta-blockers in the contemporary reperfusion era. Materials and Methods: Randomized controlled trials (RCT) and observational studies using propensity score matching, comparing use of beta-blockers with non-use of beta-blockers, in patients with AMI after discharge. The primary outcome was all-cause mortality. Odds ratios (OR) and associated 95% confidence intervals (CI) were calculated. Results: One RCT and eight observational studies, containing 47,339 patients with AMI, were included. Compared with non-use of beta-blockers, beta-blocker use after discharge may have reduced the risk of all-cause mortality (OR: 0.70, 95% CI: 0.61 to 0.80, I2 = 14.4%), cardiac death (OR: 0.63, 95% CI: 0.44 to 0.91, I2 = 22.8%), myocardial infarction (OR: 0.73, 95% CI: 0.62 to 0.86, I2 = 0), and revascularization (OR: 0.92, 95% CI: 0.85 to 0.99, I2 = 0). No significant differences were found in major adverse cardiovascular events (MACE, OR: 0.88, 95% CI: 0.66 to 1.17, I2 = 78.4%), heart failure (OR: 0.56, 95% CI: 0.29 to 1.08, I2 = 0) or stroke (OR: 1.13, 95% CI: 0.92 to 1.39, I2 = 0). For patients with preserved left ventricular function, beta-blocker use after discharge may have also reduced the risk of all-cause mortality (OR: 0.61, 95% CI: 0.44 to 0.84, I2 = 0). Conclusions: Use of beta-blockers after discharge may still be beneficial for AMI patients in the contemporary reperfusion era, with or without preserved left ventricular function.
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Kim Y, Byun S, Kim HY, Kim DB. Long-Term Beta-Blocker Therapy After Myocardial Infarction Without Heart Failure in the Reperfusion Era-Systemic Review and Meta-analysis. J Cardiovasc Pharmacol 2022; 79:650-654. [PMID: 35058412 DOI: 10.1097/fjc.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/11/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Beta-blockers are recommended as a standard treatment for patients who experience a myocardial infarction (MI). However, the evidence supporting this recommendation is based on the prereperfusion era data. This review aims to evaluate the effectiveness of long-term (≥1 year) beta-blocker therapy in post-MI patients without clinical heart failure (HF) in the reperfusion era. We included observational cohort studies, which compared at least 1 year use of beta-blockers to no beta-blockers in patients with an acute MI, but without HF. The clinical endpoint considered was all-cause mortality, except for cardiovascular death in one study. Five cohort studies and 217,532 patients were included. One study demonstrated a reduction in all-cause mortality with beta-blockers, whereas, in 4 studies, there was no difference in the death rate. The pooled estimate by random effect showed that beta-blocker treatment does not reduce mortality (odds ratio 0.800, 95% confidence interval 0.559-1.145) with high heterogeneity (I2 = 94%). This meta-analysis shows that the use of oral beta-blockers for 1 year or more does not reduce the mortality of MI patients without HF. Large randomized trials need to evaluate beta-blocker discontinuation after an acute MI.
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Affiliation(s)
- Youngju Kim
- Department of Cardiology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea ; and
| | - Sungwook Byun
- Department of Cardiology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea ; and
| | - Hee-Yeol Kim
- Department of Cardiology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea ; and
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Bin Kim
- Department of Cardiology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea ; and
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Liang C, Zhang C, Gan S, Chen X, Tan Z. Long-Term Effect of β-Blocker Use on Clinical Outcomes in Postmyocardial Infarction Patients: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:779462. [PMID: 35463744 PMCID: PMC9024047 DOI: 10.3389/fcvm.2022.779462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrior studies provided inconsistent results regarding long-term effect of β-blocker use on clinical outcomes in postmyocardial infarction (MI) patients.MethodsWe searched for articles regarding long-term effect of β-blocker use on clinical outcomes in patients after MI and published them before July 2021 in the databases as follows: PubMed, Web of Science, MEDLINE, EMBASE, and Google Scholar. STATA 12.0 software was used to compute hazard ratios (HRs) and their 95% confidence intervals (CIs).ResultsThe study indicated that β-blocker group had significantly lower long-term all-cause mortality, cardiovascular mortality, major adverse cardiac events (MACEs) in post-MI patients, compared to no β-blocker group (all-cause mortality: HR, 0.67; 95% CI: 0.56–0.80; cardiovascular mortality: HR, 0.62; 95% CI: 0.49–0.78; MACE: HR, 0.87; 95% CI: 0.75–1.00). The study indicated no significant long-term effect of β-blocker use on risk of hospitalization for heart failure (HF), risk of recurrent MI, risk of stroke, and risk of repeat revascularization in post-MI patients (risk of hospitalization for HF: HR, 0.82; 95% CI: 0.58–1.16; risk of recurrent MI: HR, 0.93; 95% CI: 0.78–1.11; risk of stroke: HR, 0.94; 95% CI: 0.79–1.12; risk of repeat revascularization: HR, 0.91; 95% CI: 0.80–1.04).ConclusionsThe meta-analysis demonstrated significant long-term effects of β-blocker use on all-cause mortality, cardiovascular mortality, and risk of MACE in post-MI patients, whereas no significant long-term effect was shown on risk of hospitalization for HF, risk of recurrent MI, risk of stroke, and risk of repeat revascularization in post-MI patients.
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Affiliation(s)
- Chunling Liang
- Department of Emergency, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Chenhao Zhang
- Department of Emergency, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Shibao Gan
- Department of General Practice, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, China
| | - Xiaojie Chen
- Department of Emergency, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhihui Tan
- Department of General Practice, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, China
- *Correspondence: Zhihui Tan
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Hoffmann F, Fassbender P, Zander W, Ulbrich L, Kuhr K, Adler C, Halbach M, Reuter H. The Hypertension Paradox: Survival Benefit After ST-Elevation Myocardial Infarction in Patients With History of Hypertension. A Prospective Cohort- and Risk-Analysis. Front Cardiovasc Med 2022; 9:785657. [PMID: 35282337 PMCID: PMC8907999 DOI: 10.3389/fcvm.2022.785657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/24/2022] [Indexed: 12/12/2022] Open
Abstract
BackgroundMortality after ST-elevation myocardial infarction (STEMI) is dependent from best-medical treatment after initial event.ObjectivesDetermining the impact of prescription of guideline-recommended therapy after STEMI in two cohorts, patients with and without history of arterial hypertension, on survival.Methods1,025 patients of the Cologne Infarction Model registry with invasively adjudicated STEMI were dichotomized according to their history of arterial hypertension. We recorded prescription rates and dosing of RAS-inhibitors, β-blockers and statins in all patients. The primary outcome was all-cause death. Mean follow-up was 2.5 years.ResultsMean age was 64 ± 13 years, 246 (25%) were women. 749 (76%) patients had a history of hypertension. All-cause mortality was 24.2%, 30-day and 1-year mortality was 11.3% and 16.6%, respectively. History of hypertension correlated with lower mortality (hazard ratio [HR], @30 days: 0.41 [0.27-0.62], @1 year: 0.37 [0.26-0.53]). After adjusting for age, sex, Killip-class, diabetes mellitus, body-mass index, kidney function and statin prescription at discharge 1-year mortality HR was 0.24 (0.12-0.48). At discharge, prescription rates for RAS-inhibitors, β-blockers and statins, as well as individual dosing and long-term persistence of RAS-inhibitors were higher in patients with history of hypertension. On the same lines, prescription rates for RAS-inhibitors, β-blockers and statins at discharge correlated significantly with lower mortality regardless of history of hypertension.ConclusionPatients with history of hypertension show higher penetration of guideline recommended drug therapy after STEMI, which may contribute to better survival. Better tolerance of β-blockers and RAS-inhibitors in patients with history of hypertension, not hypertension itself, likely explains these differences in prescription and dosing.
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Affiliation(s)
- Fabian Hoffmann
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
- Department of Cardiovascular Aerospace Medicine, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Patricia Fassbender
- Department of Internal Medicine, Evangelisches Klinikum Köln Weyertal, Cologne, Germany
| | - Wilhelm Zander
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Lisa Ulbrich
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Kathrin Kuhr
- Medical Faculty, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, Cologne, Germany
| | - Christoph Adler
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
- Fire Department City of Cologne, Institute for Security Science and Rescue Technology, Cologne, Germany
| | - Marcel Halbach
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Hannes Reuter
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
- Department of Internal Medicine, Evangelisches Klinikum Köln Weyertal, Cologne, Germany
- *Correspondence: Hannes Reuter
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10
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Huang HC, Yu PH, Tsai MS, Chien KL, Chen WJ, Huang CH. Prior beta-blocker treatment improves outcomes in out-of-hospital cardiac arrest patients with non-shockable rhythms. Sci Rep 2021; 11:16804. [PMID: 34413355 PMCID: PMC8377081 DOI: 10.1038/s41598-021-96070-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022] Open
Abstract
The prognosis of out of cardiac arrest is poor and most cardiac arrest patients suffered from the non-shockable rhythm especially in patients without pre-existing cardiovascular diseases and medication prescription. Beta-blocker (ß-blocker) therapy has been shown to improve outcomes in cardiovascular diseases such as heart failure, ischemia related cardiac, and brain injuries. Therefore, we investigated whether prior ß-blockers use was associated with reduced mortality in patients with cardiac arrest and non-shockable rhythm. We conducted a population-based retrospective cohort study using multivariate propensity score-based regression to control for differences among patients with cardiac arrest. A total of 104,568 adult patients suffering a non-traumatic and non-shockable rhythm cardiac arrest between 2005 and 2011 were identified. ß-blocker prescription at least 30 days prior to the cardiac arrest event was defines as the ß-blockers group. We chose 12.5 mg carvedilol as the cut-off value and defined greater or equal to carvedilol 12.5 mg per day and its equivalent dose as high-dose group. After multivariate propensity score-based logistic regression analysis, patients with prior ß-blockers use were associated with better 1-year survival [adjusted odds ratio (OR), 1.15, 95% confidence interval (CI) 1.01-1.30; P = 0.031]. Compared to non-ß-blocker use group and prior low-dose ß-blockers use group, prior high-dose ß-blockers use group was associated with higher mechanical ventilator wean success rate (adjusted OR 1.19, 95% CI 1.01-1.41, P = 0.042). In conclusion, prior high dose ß-blockers use was associated with a better 1-year survival and higher weaning rate in patients with non-shockable cardiac arrest.
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Affiliation(s)
- Hui-Chun Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ping-Hsun Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Rd., Taipei, 100, Taiwan
| | - Kuo-Liong Chien
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Rd., Taipei, 100, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Rd., Taipei, 100, Taiwan.
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11
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Abstract
ABSTRACT Using guideline-driven interventions, NPs are well suited for management of ST-segment elevation (STE)-acute coronary syndrome (ACS). This second article in a two-part series on ACS management presents an updated overview to help NPs in applying evidence-based interventions while caring for patients with STE-ACS.
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12
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Ferreira JA, Baptista RM, Monteiro SR, Gonçalves LM. Usefulness of universal beta-blocker therapy in patients after ST-elevation myocardial infarction. Medicine (Baltimore) 2021; 100:e23987. [PMID: 33545989 PMCID: PMC7837933 DOI: 10.1097/md.0000000000023987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
The use of beta-blockers (BB) in the context of ST-segment elevation myocardial infarction (STEMI) was a universal practice in the pre-reperfusion era. Since then, evidence of their use for secondary prevention after STEMI is scarce. Our aim is to determine treatment results associated with BB therapy after a STEMI at 1-year follow-up in a contemporary nationwide cohort.A prospective analysis involving 49 national centers, including patients admitted with STEMI, enrolled between October 2010 and September 2019 was conducted. The primary outcome was defined as the composite of all-cause mortality or hospital re-admission for a cardiovascular (CV) cause in the first year after STEMI. The patients were distributed into 2 groups, depending on whether they received therapy with BB at hospital discharge or not (BB and NB group, respectively).A total of 3145 patients were included in the analysis, of which 2526 (80.3%) in the BB group. A total of 12.2% of patients reached the primary outcome. Regarding the univariate Cox regression analysis, the BB group presented lower mortality or re-admission for CV cause at 1-year follow-up [hazard ratio (HR) 0.69, confidence interval (CI) 95% 0.55-0.87, P = .001]. However, after adjustment for significant covariates, this association was lost (HR 0.73, CI 95% 0.51-1.04, P = .081). In patients with preserved (HR 0.73, CI 95% 0.51-1.04, P = .081) and mid-range (HR 1.01, CI 95% 0.64-1.61, P = .959) left ventricular ejection fraction (LVEF), the primary outcome was similar between the 2 groups, while in patients with reduced LVEF, the BB group presented a better prognosis, with fewer patients reaching the primary outcome (HR 0.431, CI 95% 0.262-0.703, P = .001).BB universal therapy after STEMI has not proved useful, but it seems to be beneficial in patients with reduced LVEF.
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Affiliation(s)
| | - Rui Miguel Baptista
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra
- iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Lino Manuel Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra
- iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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13
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Maqsood MH, Alam M, Atar D, Birnbaum Y. Efficacy of Long-Term Oral Beta-Blocker Therapy in Patients Who Underwent Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction With Preserved Left Ventricular Ejection Fraction: A Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2021; 77:87-93. [PMID: 33136764 DOI: 10.1097/fjc.0000000000000922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/14/2020] [Indexed: 01/11/2023]
Abstract
ABSTRACT After the results of the first multicenter, prospective randomized clinical trial (RCT) evaluating long-term efficacy of oral beta-blockers in patients with preserved left ventricular ejection fraction (LVEF) after ST elevation myocardial infarction (STEMI), we decided to conduct an updated systematic review and meta-analysis to evaluate the long-term efficacy of oral beta-blocker use in patients with preserved LVEF who underwent percutaneous coronary intervention (PCI) for STEMI. A time-limited search from January 1, 1999, to April 16, 2020, on PubMed and EMBASE was conducted on April 16, 2020, for observational studies and clinical trials evaluating the efficacy of long-term oral beta-blockers in patients with preserved LVEF after STEMI treated with PCI. The comparative outcomes between beta-blockers and non-beta-blockers were assessed by pooling weighted odds ratio (OR) with 95% confidence interval (CI) using random-effects model. The outcomes of interest were all-cause mortality and major adverse cardiac event (MACE). Twelve studies (11 observational and 1 RCT) comprising 32,108 patients (19,740 on beta-blocker therapy and 12,368 without beta-blocker therapy) were included. Of which, 75% percent were male (mean age of 64 years: 63.87 ± 3.01 years on beta-blocker therapy and 64.76 ± 3.02 years on non-beta-blocker therapy; P = 0.129) with a follow-up of up to 4.7 years. Unadjusted all-cause mortality [OR = 0.58 (95% CI: 0.42-0.79)] and adjusted all-cause mortality [OR = 0.64 (95% CI: 0.48-0.87)] were significantly lower in patients on the long-term beta-blocker therapy group. However, unadjusted MACE [OR = 0.87 (95% CI: 0.70-1.08)] was not reduced with beta-blocker therapy in these patients. Patients with preserved LVEF after STEMI treated with PCI on long-term oral beta-blocker therapy have a significant reduction in risk of all-cause mortality, without an effect on MACE rates. The only RCT included showed neutral effect, so results of ongoing RCTs are anticipated. Considering that the only high-quality data (RCT) suggest a neutral effect, one should be cautious in interpreting the conclusion.
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Affiliation(s)
- Muhammad H Maqsood
- The Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mahboob Alam
- The Department of Medicine, The Section of Cardiology, Baylor College of Medicine, Houston, TX; and
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway, and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Yochai Birnbaum
- The Department of Medicine, The Section of Cardiology, Baylor College of Medicine, Houston, TX; and
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14
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Kluge N, Dacey M, Hadaya J, Shivkumar K, Chan SA, Ardell JL, Smith C. Rapid measurement of cardiac neuropeptide dynamics by capacitive immunoprobe in the porcine heart. Am J Physiol Heart Circ Physiol 2021; 320:H66-H76. [PMID: 33095651 PMCID: PMC7847069 DOI: 10.1152/ajpheart.00674.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 01/09/2023]
Abstract
Sympathetic control of regional cardiac function occurs through postganglionic innervation from stellate ganglia and thoracic sympathetic chain. Whereas norepinephrine (NE) is their primary neurotransmitter, neuropeptide Y (NPY) is an abundant cardiac cotransmitter. NPY plays a vital role in homeostatic processes including angiogenesis, vasoconstriction, and cardiac remodeling. Elevated sympathetic stress, resulting in increased NE and NPY release, has been implicated in the pathogenesis of several cardiovascular disorders including hypertension, myocardial infarction, heart failure, and arrhythmias, which may result in sudden cardiac death. Current methods for the detection of NPY in myocardium are limited in their spatial and temporal resolution and take days to weeks to provide results [e.g., interstitial microdialysis with subsequent analysis by enzyme-linked immunosorbent assay (ELISA), high performance liquid chromatography (HPLC), or mass spectrometry]. In this study, we report a novel approach for measurement of interstitial and intravascular NPY using a minimally invasive capacitive immunoprobe (C.I. probe). The first high-spatial and temporal resolution, multichannel measurements of NPY release in vivo are provided in both myocardium and transcardiac vascular space in a beating porcine heart. We provide NPY responses evoked by sympathetic stimulation and ectopic ventricular pacing and compare these to NE release and hemodynamic responses. We extend this approach to measure both NPY and vasoactive intestinal peptide (VIP) and show differential release profiles under sympathetic stimulation. Our data demonstrate rapid and local changes in neurotransmitter profiles in response to sympathetic cardiac stressors. Future implementations include real-time intraoperative determination of cardiac neuropeptides and deployment as a minimally invasive catheter.NEW & NOTEWORTHY The sympathetic nervous system regulates cardiac function through release of neurotransmitters and neuropeptides within the myocardium. Neuropeptide Y (NPY) acts as an acute cardiac vasoconstrictor and chronically to regulate angiogenesis and cardiac remodeling. Current methodologies for the measure of NPY are not capable of providing rapid readouts on a single-sample basis. Here we provide the first in vivo methodology to report dynamic, localized NPY levels within both myocardium and vascular compartments in a beating heart.
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Affiliation(s)
- Nicholas Kluge
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
| | - Michael Dacey
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California
- UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
- Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, California
| | - Joseph Hadaya
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California
- UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
- Molecular, Cellular, and Integrative Physiology Program, University of California, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California
- UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Shyue-An Chan
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey L Ardell
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California
- UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Corey Smith
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
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15
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Park J, Han JK, Kang J, Chae IH, Lee SY, Choi YJ, Rhew JY, Rha SW, Shin ES, Woo SI, Lee HC, Chun KJ, Kim DI, Jeong JO, Bae JW, Yang HM, Park KW, Kang HJ, Koo BK, Kim HS. Optimal Dose and Type of β-blockers in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2020; 137:12-19. [PMID: 32998005 DOI: 10.1016/j.amjcard.2020.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022]
Abstract
The clinical benefit of β-blockers in modern reperfusion era is not well determined. We investigated the impact of β-blockers in acute coronary syndrome (ACS) after percutaneous coronary intervention. From the Grand-DES registry, a patient-level pooled registry consisting of 5 Korean multicenter prospective drug-eluting stent registries, a total of 6,690 ACS patients were included. Prescription records of dose and type of β-blockers were investigated trimonthly from discharge. Patients were categorized by the mean value of doses during the follow-up (≥50% [high-dose], ≥25% to <50% [medium-dose], and <25% [low-dose] of the full dose that was used in each randomized clinical trial) and vasodilating property of β-blockers. Three-year cumulative risk of all-cause death, cardiac death, and myocardial infarction were assessed. Patients receiving β-blockers were associated with a lower risk of all-cause and cardiac death compared with those not receiving β-blockers (adjusted hazard ratio [aHR] 0.29, 95% confidence interval [CI] 0.24 to 0.35 for all-cause death; aHR 0.27, 95% CI 0.21 to 0.34 for cardiac death). Medium-dose β-blocker group was associated with a lower risk of cardiac death compared with high- and low-dose β-blocker groups (aHR 0.49, 95% CI 0.25 to 0.96, for high-dose; aHR 0.46, 95% CI 0.29 to 0.74, for low-dose). Patients receiving vasodilating β-blockers were associated with a lower risk of cardiac death compared with those receiving conventional β-blockers (aHR 0.58, 95% CI 0.40 to 0.84). In conclusion, β-blocker therapy was associated with better clinical outcomes in patients with ACS, especially with medium-dose and vasodilating β-blockers.
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Affiliation(s)
- Jiesuck Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeehoon Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sung Yun Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Young Jin Choi
- Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jay Young Rhew
- Department of Internal Medicine and Cardiovascular Center, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan Medical Center, Ulsan, Republic of Korea
| | - Seong-Ill Woo
- Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Han Cheol Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kook-Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University college of Medicine, Busan, Republic of Korea
| | - Jin-Ok Jeong
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejon, Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Han-Mo Yang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Woo Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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16
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The impact of optimal medical therapy on patients with recurrent acute myocardial infarction: Subanalysis from the BleeMACS study. Int J Cardiol 2020; 318:1-6. [PMID: 32598995 DOI: 10.1016/j.ijcard.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/21/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) recurrence is still high despite great progress in secondary prevention. Patients with recurrent AMI suffer worse prognosis compared to those with first AMI. The objective was to evaluate the effect of optimal medical therapy (OMT) on these patients with recurrent AMI. METHODS AND RESULTS Sub-analysis was performed including 13,343 patients with AMI from the international multicenter Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome (BleeMACS) registry. OMT was defined as the combination of aspirin, any P2Y12 inhibitor, statin, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, and beta-blocker. Among 1285 patients with prior AMI, 56.8% received OMT prescription. Patients receiving OMT suffered from less congestive heart failure, peripheral artery disease, malignancy, and bleeding history. Kaplan-Meier survival estimates revealed that OMT was strongly related to decreased in all-cause death (4.2% vs. 10.1%, p < .001) and the composite endpoint of death/re-AMI (11.1% vs. 16.9%, p = .005) at 1-year follow-up. OMT was the independent protect factor of primary endpoint even after adjusting for multiple possible confounders (HR, 0.46; 95% CI, 0.27-0.78; p = .004). However, no significant difference was observed regarding re-AMI between OMT and non-OMT groups. OMT also reduced all-cause death in patients with recurrent AMI after propensity score matching. CONCLUSIONS The prescription of OMT was seriously insufficient in patients with recurrent AMI, especially high-risk patients, even though OMT was associated with improved prognosis. Further improvements in pharmacological therapy are needed to reduce subsequent recurrent events.
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17
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Kim HK, Ahn Y, Chang K, Jeong YH, Hahn JY, Choo EH, Kim MC, Kim HS, Kim W, Cho MC, Jang Y, Kim CJ, Jeong MH, Chae SC. 2020 Korean Society of Myocardial Infarction Expert Consensus Document on Pharmacotherapy for Acute Myocardial Infarction. Korean Circ J 2020; 50:845-866. [PMID: 32969206 PMCID: PMC7515755 DOI: 10.4070/kcj.2020.0196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/01/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023] Open
Abstract
Clinical practice guidelines published by the European Society of Cardiology and the American College of Cardiology/American Heart Association summarize the available evidence and provide recommendations for health professionals to enable appropriate clinical decisions and improve clinical outcomes for patients with acute myocardial infarction (AMI). However, most current guidelines are based on studies in non-Asian populations in the pre-percutaneous coronary intervention (PCI) era. The Korea Acute Myocardial Infarction Registry is the first nationwide registry to document many aspects of AMI from baseline characteristics to treatment strategies. There are well-organized ongoing and published randomized control trials especially for antiplatelet therapy among Korean patients with AMI. Here, members of the Task Force of the Korean Society of Myocardial Infarction review recent published studies during the current PCI era, and have summarized the expert consensus for the pharmacotherapy of AMI.
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Affiliation(s)
- Hyun Kuk Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Joo Yong Hahn
- Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyo Soo Kim
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea
| | - Weon Kim
- Division of Cardiovascular, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Yangsoo Jang
- Cardiology Division, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chong Jin Kim
- Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea.
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18
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Peck KY, Andrianopoulos N, Dinh D, Roberts L, Duffy SJ, Sebastian M, Clark D, Brennan A, Oqueli E, Ajani AE, Reid CM, Freeman M, Teh AW. Role of beta blockers following percutaneous coronary intervention for acute coronary syndrome. Heart 2020; 107:728-733. [PMID: 32887736 DOI: 10.1136/heartjnl-2020-316605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 11/03/2022] Open
Abstract
AIMS There is a paucity of evidence supporting routine beta blocker (BB) use in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). The aim of this study was to evaluate BB use post PCI and its association with mortality. Furthermore, the study aimed to evaluate the association between BB and mortality in the subgroups of patients with left ventricular ejection fraction (LVEF) <35%, LVEF 35%-50% and LVEF >50%. METHODS Using a large PCI registry, data from patients with ACS between January 2005 and June 2017 who were alive at 30 days were analysed. Those patients taking BB at 30 days were compared with those who were not taking BB. The primary outcome was all-cause mortality. The mean follow-up was 5.3±3.5 years. RESULTS Of the 17 562 patients, 83.3% were on BB. Mortality was lower in the BB group (13.1% vs 19.5%, p=0.0001). Multivariable Cox proportional hazards model showed that BB use was associated with lower overall mortality (adjusted HR 0.87, 95% CI 0.78 to 0.97, p=0.014). In the subgroup analysis, BB use was associated with reduced mortality in LVEF <35% (adjusted HR 0.63, 95% CI 0.44 to 0.91, p=0.013), LVEF 35%-50% (adjusted HR 0.80, 95% CI 0.68 to 0.95, p=0.01), but not LVEF >50% (adjusted HR 1.03, 95% CI 0.87 to 1.21, p=0.74). CONCLUSION BB use remains high and is associated with reduced mortality. This reduction in mortality is primarily seen in those with reduced ejection fraction, but not in those with preserved ejection fraction.
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Affiliation(s)
- Kah Yong Peck
- Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louise Roberts
- Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Cardiovascular Medicine, Alfred Health, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Martin Sebastian
- Department of Cardiology, Barwon Health, University Hospital, Geelong, Victoria, Australia
| | - David Clark
- Department of Cardiology, The University of Melbourne, Austin Hospital Clinical School, Melbourne, Victoria, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia.,School of Medicine, Deakin University, Ballarat, Victoria, Australia
| | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia .,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Cardiology, The University of Melbourne, Austin Hospital Clinical School, Melbourne, Victoria, Australia
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19
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Impacto pronóstico de la adherencia secundaria a betabloqueantes tras infarto de miocardio con elevación del segmento ST sin disfunción ventricular. Med Clin (Barc) 2020; 155:242-248. [DOI: 10.1016/j.medcli.2019.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/16/2019] [Accepted: 11/28/2019] [Indexed: 12/19/2022]
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20
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Harari R, Bangalore S. Beta-blockers after acute myocardial infarction: an old drug in urgent need of new evidence! Eur Heart J 2020; 41:3530-3532. [DOI: 10.1093/eurheartj/ehaa436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Rafael Harari
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, USA
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, USA
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21
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Kim J, Kang D, Park H, Kang M, Park TK, Lee JM, Yang JH, Song YB, Choi JH, Choi SH, Gwon HC, Guallar E, Cho J, Hahn JY. Long-term β-blocker therapy and clinical outcomes after acute myocardial infarction in patients without heart failure: nationwide cohort study. Eur Heart J 2020; 41:3521-3529. [DOI: 10.1093/eurheartj/ehaa376] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/05/2020] [Accepted: 04/22/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
To investigate the association between long-term β-blocker therapy and clinical outcomes in patients without heart failure (HF) after acute myocardial infarction (AMI).
Method and results
Between 2010 and 2015, a total of 28 970 patients who underwent coronary revascularization for AMI with β-blocker prescription at hospital discharge and were event-free from death, recurrent myocardial infarction (MI), or HF for 1 year were enrolled from Korean nationwide medical insurance data. The primary outcome was all-cause death. The secondary outcomes were recurrent MI, hospitalization for new HF, and a composite of all-cause death, recurrent MI, or hospitalization for new HF. Outcomes were compared between β-blocker therapy for ≥1 year (N = 22 707) and β-blocker therapy for <1 year (N = 6263) using landmark analysis at 1 year after index MI. Compared with patients receiving β-blocker therapy for <1 year, those receiving β-blocker therapy for ≥1 year had significantly lower risks of all-cause death [adjusted hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.72–0.91] and composite of all-cause death, recurrent MI, or hospitalization for new HF (adjusted HR 0.82; 95% CI 0.75–0.89), but not the risks of recurrent MI or hospitalization for new HF. The lower risk of all-cause death associated with persistent β-blocker therapy was observed beyond 2 years (adjusted HR 0.86; 95% CI 0.75–0.99) but not beyond 3 years (adjusted HR 0.87; 95% CI 0.73–1.03) after MI.
Conclusion
In this nationwide cohort, β-blocker therapy for ≥1 year after MI was associated with reduced all-cause death among patients with AMI without HF.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Minwoong Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
- Department s of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
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22
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Joo SJ, Kim SY, Choi JH, Park HK, Beom JW, Lee JG, Chae SC, Kim HS, Kim YJ, Cho MC, Kim CJ, Rha SW, Yoon J, Jeong MH. Effect of beta-blocker therapy in patients with or without left ventricular systolic dysfunction after acute myocardial infarction. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:475-482. [DOI: 10.1093/ehjcvp/pvaa029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/07/2020] [Accepted: 04/08/2020] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
This observational study aimed to investigate the association between beta-blocker therapy and clinical outcomes in patients with acute myocardial infarction (AMI), especially with mid-range or preserved left ventricular systolic function.
Methods and results
Among 13 624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), 12 200 in-hospital survivors were selected. Patients with beta-blockers showed significantly lower 1-year major adverse cardiac events (MACE), which was a composite of cardiac death, MI, revascularization, and readmission due to heart failure [9.7 vs. 14.3/100 patient-year; hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.72–0.97; P = 0.022). However, this association had a significant interaction with left ventricular ejection fraction (LVEF). Beta-blocker therapy at discharge was associated with lower 1-year MACE in patients with LVEF ≤40% (HR 0.63, 95% CI 0.48–0.81; P < 0.001), and 40% <LVEF < 50% (HR 0.69, 95% CI 0.51–0.94; P = 0.020), but not in patients with LVEF ≥50% (HR 1.16, 95% CI 0.91–1.48; P = 0.234).
Conclusions
Beta-blocker therapy at discharge was associated with better 1-year clinical outcomes in patients with reduced or mid-range LVEF after AMI, but not in patients with preserved LVEF. These data suggested that the long-term beta-blocker therapy may be guided by LVEF.
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Affiliation(s)
- Seung-Jae Joo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Song-Yi Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Joon-Hyouk Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Hyeung Keun Park
- Department of Health Policy and Management, Jeju National University School of Medicine, Republic of Korea
| | - Jong Wook Beom
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Jae-Geun Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyunghee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Junghan Yoon
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
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23
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Kang SJ. Clinical Impact of Beta-blockers in the Revascularization Era. Korean Circ J 2020; 50:509-510. [PMID: 32419403 PMCID: PMC7234848 DOI: 10.4070/kcj.2020.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Soo Jin Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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24
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Association of β-Blocker Therapy at Discharge with Clinical Outcomes after Acute Coronary Syndrome in Patients without Heart Failure. Cardiovasc Ther 2020; 2020:4351469. [PMID: 32405323 PMCID: PMC7196986 DOI: 10.1155/2020/4351469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 11/18/2022] Open
Abstract
Aim To evaluate the clinical impact of β-blocker in patients with adequate left ventricular ejection function (LVEF) who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods A total of 10,724 consecutive patients who underwent PCI throughout 2013 were prospectively enrolled in the study. Among these, we analyzed 5,631 ACS patients who were discharged with LVEF ≥ 40%. Patients were then compared according to the β-blocker prescription at discharge. Results During a 2-year follow-up, no significant association was observed of β-blocker use with all-cause mortality (with β-blockers 47/5,043 (0.9%) vs. without β-blocker use 8/588 (1.4%); hazard ratio (HR) 0.762, 95% confidence interval 0.36 to 1.64; P = 0.485), cardiac death, myocardial infarction (MI), or major adverse cardiovascular and cerebrovascular events. Subgroup analysis demonstrated that the β-blocker use at discharge reduced the 2-year mortality in patients with unstable angina (UA) (HR 0.42, 95% CI 0.19 to 0.94, P = 0.034). Landmark analysis at 1 year showed that patients with UA who were discharged with β-blockers had lower mortality (HR 0.17, 95% CI 0.04-0.65, P = 0.010) and cardiac death (HR 0.12, 95% CI 0.01-0.99, P = 0.049) than those discharged without β-blockers. However, the benefit was lost beyond 1 year. No differences in outcomes were recorded in the AMI or overall population. Conclusions We present that β-blocker significantly lowers the rate of all-cause death up to 1 year, in UA patients who have undergone PCI and have adequate LVEF. Its role in patients with AMI also deserves further exploration.
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25
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Allonen J, Nieminen MS, Sinisalo J. Poor adherence to beta-blockers is associated with increased long-term mortality even beyond the first year after an acute coronary syndrome event. Ann Med 2020; 52:74-84. [PMID: 32149544 PMCID: PMC7877966 DOI: 10.1080/07853890.2020.1740938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Acute coronary syndrome (ACS) patients are widely treated with long-term beta-blocker therapy after cardiac event. Especially for low-risk patients, the benefits of beta-blockers on survival and the optimal therapy duration remain unclear. We investigated the effect of adherence to beta-blockers on long-term survival of ACS patients.Methods and results: A total of 1855 consecutive ACS patients who underwent angiography and survived 30 days after were followed for a median of 8.6 years. During follow-up, 30.1% (n = 558) of patients died. Adherence was assessed as yearly periods covered by medication purchases and investigated as a dynamic time-dependent variable in Cox proportional hazards models. In a univariable model, non-adherence to beta-blockers was associated with higher all-cause mortality (Hazard ratio [HR] 2.99, 95% confidence interval [CI] 2.50-3.57; p < .001). Results were similar in multivariable models on both overall survival (HR 1.84, 95% CI 1.51-2.24; p < .001) and on 1-year landmark survival (HR 1.74, 95% CI 1.41-2.14; p < .001). In subgroup analyses, the increase in all-cause mortality was consistent among low-risk patients (HR 1.60, 95% CI 1.16-2.21; p = .004).Conclusion: Poor adherence to beta-blockers is associated with increased long-term mortality among ACS patients. Even low-risk patients seem to benefit from long-term beta-blocker therapy.Key messagesAdherence to secondary prevention medications diminishes drastically over the years after an ACS event.Non-adherence to β-blockers is associated with increased long-term mortality of ACS patients, and the effect on survival extends beyond the first year after an ACS event.Our follow-up was exceptionally lengthy with median follow-up period of 8.6 years.
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Affiliation(s)
- Jaakko Allonen
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Markku S Nieminen
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
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26
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Jang HJ, Suh J, Kwon SW, Park SD, Oh PC, Moon J, Lee K, Kang WC, Jung IH, An H, Kim TH. The selection of β-blocker after successful reperfusion in patients with ST-elevation myocardial infarction. Perfusion 2020; 35:338-347. [DOI: 10.1177/0267659119878396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The selection of β-blocker for survivors after primary intervention due to acute ST-elevation myocardial infarction seems crucial to improve the outcomes. However, rare comparison data existed for these patients. We aimed to compare the effectiveness of selective β-blockers to that of carvedilol in patients treated with primary intervention. Methods and results: Among the 1,485 patients in the “INTERSTELLAR” registry between 2007 and 2015, 238 patients with selective β-blockers (bisoprolol, nebivolol, atenolol, bevantolol, and betaxolol) and 988 with carvedilol were included and their clinical outcomes were compared for a 2-year observation period. In the clinical baseline characteristics, the unfavorable trends in the carvedilol group were high Killip presentation, lower ejection fractions, smaller diameters, and longer lengths of deployed stents. Although mortality (2.5% vs. 1.7%; p = 0.414) and the rate of stroke (0.8% vs. 0.6%; p = 0.693) were not different between groups, the rate of recurrent myocardial infarction (4.6% vs. 1.2%; p = 0.001) and of target vessel revascularization (4.2% vs. 0.9%; p < 0.001) were lower in the carvedilol group. After eliminating the difference by propensity matching, the similar outcome result was shown (all-cause death, 0.6% vs. 1.0%, p = 0.678; stroke, 0.6% vs. 1.2%, p = 0.479; myocardial infarction, 5.0% vs. 1.2%, p = 0.003; target vessel revascularization, 4.5% vs. 0.7%, p < 0.006) for 595 matched populations. The use of carvedilol was also determined to be an independent predictor for recurrent myocardial infarctions (hazard ratio = 0.305; p = 0.005; 95% confidence interval = 0.13-0.69). Conclusion: Use of a carvedilol in ST-segment myocardial infarction survivor is associated with lower recurrent myocardial infarction events. Thus, it might be the better choice of β-blocker for secondary prevention in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention.
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Affiliation(s)
- Ho-Jun Jang
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon-si, Republic of Korea
| | - Jon Suh
- Division of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon-si, Republic of Korea
| | - Sung Woo Kwon
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jeonggeun Moon
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Kyounghoon Lee
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Woong Chol Kang
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - In Hyun Jung
- Division of Cardiology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon-si, Republic of Korea
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27
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Hagsund T, Olsson SE, Smith JG, Madsen Hardig B, Wagner H. β-blockers after myocardial infarction and 1-year clinical outcome - a retrospective study. BMC Cardiovasc Disord 2020; 20:165. [PMID: 32272880 PMCID: PMC7146968 DOI: 10.1186/s12872-020-01441-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 03/18/2020] [Indexed: 12/28/2022] Open
Abstract
Background Long term β-blocker therapy after myocardial infarction (MI) reduces mortality and recurrent MI but evidence for this treatment predates contemporary acute coronary care. β-blocker treatment is a key quality of care indicator in the Swedish national quality register for acute coronary care, Riks-HIA. Between 2011 and 2015 a declining number of MI-patients discharged with a β-blocker from the coronary care unit (CCU) at Helsingborg and other hospitals was reported. This retrospective observational study aimed to investigate the causes for discharge without a β-blocker and relate it to outcome, compared to patients discharged with a β-blocker. Methods MI-patients registered in Riks-HIA discharged without β-blocker during 2011–2015 (no-β-group) and a control group (β-group) comprised of patients discharged with β-blocker treatment between January 1 to December 31, 2013, were matched by RIKS-HIA criteria for β-blocker use. Clinical characteristics, date of death, readmission for MI, other cardiovascular events were collected from Riks-HIA and medical records. Results The no-β-group included 141 patients, where 65.2% had a justified reason for non-β-blocker use. The β-group included 206 patients. There was no difference in cardiovascular risk factor profile. There were a trend towards a higher number of readmissions for MI in the no-β-group was (n = 8 (5.7%) vs n = 2 (1.0%), p = 0.02), but not mortality (6 (4.3%) vs 2 (1.0%), p = 0.07) and combined readmission for angina pectoris, heart failure, arrhythmias or stroke/TIA (n = 23 (16.3%) vs n = 25 (12.1%), p = 0.27). Conclusion A majority of the patients in the no-β-group had a justified absence of a β-blocker. β-blocker treatment post-MI showed a trend towards fewer readmissions for MI. But important quality information is lacking to make a firm conclusion of the effect on outcome.
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Affiliation(s)
- Tora Hagsund
- Medical faculty, Lund University, 22242, Lund, Sweden
| | - Sven-Erik Olsson
- Department of Cardiology, Helsingborg Hospital, 251 87, Helsingborg, Sweden
| | - J Gustav Smith
- Department of Cardiology, Lund University, 22242, Lund, Sweden
| | | | - Henrik Wagner
- Department of Cardiology, Lund University, 22242, Lund, Sweden.
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28
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Won H, Suh Y, Kim GS, Ko YG, Hong MK. Clinical Impact of Beta Blockers in Patients with Myocardial Infarction from the Korean National Health Insurance Database. Korean Circ J 2020; 50:499-508. [PMID: 32096355 PMCID: PMC7234850 DOI: 10.4070/kcj.2019.0231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/29/2019] [Accepted: 12/04/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Whether beta blockers favorably impact the clinical outcome in patients with acute myocardial infarction (AMI) remains in debate. We investigated the impact of beta blocker on major clinical outcomes during 2 years after percutaneous coronary intervention (PCI) in patients with AMI. METHODS All patients with the first AMI treated with PCI for the period of 2005 to 2014 from the Korean National Health Insurance Service claims database were enrolled. We defined the regular user as medication possession ratio (MPR) ≥80% and non-user as MPR=0%. We compared the occurrence of all cause death, myocardial infarction (MI) and stroke according to adherence of beta-blockers. A 1:1 propensity score-matching was conducted to adjust for between-group differences. RESULTS We identified a total 81,752 patients with met eligible criteria. At discharge, 63,885 (78%) patients were prescribed beta blockers. For 2 years follow up period, regular users were 53,991 (66%) patients, non-users were 10,991 (13%). In the propensity score matched population, regular use of beta blocker was associated with a 36% reduced risk of composite adverse events (all death, MI or stroke) (hazard ratio [HR], 0.636; 95% confidence interval [CI], 0.555-0.728; p<0.001). Compared to no use of beta blocker, regular use significantly reduced all death (HR, 0.736; 95% CI, 0.668-0.812; p<0.001), MI (HR, 0.729; 95% CI, 0.611-0.803; p<0.001) and stroke (HR, 0.717; 95% CI, 0.650-0.791; p<0.001). CONCLUSIONS Prescription of beta blocker in patients with AMI after PCI was sequentially increased. Continuous regular use of beta blocker for 2 years after AMI reduced major adverse events compared to no use of beta blocker.
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Affiliation(s)
- Hoyoun Won
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yongsung Suh
- Department of Cardiology, Myongji Hospital, Goyang, Korea
| | - Gwang Sil Kim
- Department of Cardiology, Sanggye-Paik Hospital, Inje Universiy College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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29
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Sim DS, Hyun DY, Jeong MH, Kim HS, Chang K, Choi DJ, Han KR, Ahn TH, Bae JH, Choi SW, Park JS, Hur SH, Chae JK, Oh SK, Cha KS, Hwang JY. Effect of Low-Dose Nebivolol in Patients with Acute Myocardial Infarction: A Multi-Center Observational Study. Chonnam Med J 2020; 56:55-61. [PMID: 32021843 PMCID: PMC6976776 DOI: 10.4068/cmj.2020.56.1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/12/2019] [Accepted: 11/27/2019] [Indexed: 11/28/2022] Open
Abstract
The optimal dose of beta blockers after acute myocardial infarction (MI) remains uncertain. We evaluated the effectiveness of low-dose nebivolol, a beta1 blocker and a vasodilator, in patients with acute MI. A total of 625 patients with acute MI from 14 teaching hospitals in Korea were divided into 2 groups according to the dose of nebivolol (nebistol®, Elyson Pharmaceutical Co., Ltd., Seoul, Korea): low-dose group (1.25 mg daily, n=219) and usual- to high-dose group (≥2.5 mg daily, n=406). The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE, composite of death from any cause, non-fatal MI, stroke, repeat revascularization, rehospitalization for unstable angina or heart failure) at 12 months. After adjustment using inverse probability of treatment weighting, the rates of MACCE were not different between the low-dose and the usual- to high-dose groups (2.8% and 3.1%, respectively; hazard ratio: 0.92, 95% confidence interval: 0.38 to 2.24, p=0.860). The low-dose nebivolol group showed higher rates of MI than the usual- to high-dose group (1.2% and 0%, p=0.008). The 2 groups had similar rates of death from any cause (1.1% and 0.3%, p=0.273), stroke (0.4% and 1.1%, p=0.384), repeat PCI (1.2% and 0.8%, p=0.428), rehospitalization for unstable angina (1.2% and 1.0%, p=0.743) and for heart failure (0.6% and 0.7%, p=0.832). In patients with acute MI, the rates of MACCE for low-dose and usual- to high-dose nebivolol were not significantly different at 12-month follow-up.
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Affiliation(s)
- Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwanjgu, Korea
| | - Dae Young Hyun
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwanjgu, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwanjgu, Korea
| | - Hyo Soo Kim
- Department of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Kiyuk Chang
- Department of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong Ju Choi
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoo Rok Han
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Tae Hoon Ahn
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jang Hwan Bae
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Si Wan Choi
- Department of Cardiology, Chungnam National University, Daejeon, Korea
| | - Jong Seon Park
- Division of Cardiology, Yeungnam University Hospital, Daegu, Korea
| | - Seung Ho Hur
- Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jei Keon Chae
- Department of Cardiology, Chunbuk National University Hospital, Jeonju, Korea
| | - Seok Kyu Oh
- Deparment of Cardiology, Wonkwang University Hospital, Iksan, Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Jin Yong Hwang
- Department of Cardiology, Kyungsang National University Hospital, Jinju, Korea
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30
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Shavadia JS, Zheng Y, Green JB, Armstrong PW, Westerhout CM, McGuire DK, Cornel JH, Holman RR, Peterson ED. Associations between β-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease. Am Heart J 2019; 218:92-99. [PMID: 31715435 DOI: 10.1016/j.ahj.2019.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/16/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND The effects of β-blocker therapy in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD) are unclear. We sought to evaluate associations between β-blocker use in T2D with ASCVD and cardiovascular (CV) outcomes. METHODS In patients with T2D and ASCVD enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), an inverse probability of treatment-weighted Cox proportional hazards model was used to examine the association between baseline β-blocker therapy (at randomization) and the primary CV composite (defined as CV death, non-fatal myocardial infarction [MI], non-fatal stroke, or hospitalization for unstable angina), including in subgroups with prior MI and heart failure (HF); other outcomes evaluated included individual components of the primary composite, hospitalization for HF, and severe hypoglycemic events. RESULTS Of the 14,671 patients randomized, 9322 (64%) were on a β-blocker at baseline; these patients were more likely to have prior MI or HF. Over a median 3.0 (25th, 75th percentile: 2.2, 3.6) years, the risk of the primary CV composite was significantly higher with baseline β-blocker use versus no β-blocker use (4.5 vs. 3.4 events/100-patient years, adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05-1.29); no significant interaction was noted for patients with versus without prior MI or HF. Baseline β-blocker use was not associated with risks for severe hypoglycemic events (HR 1.14, 95% CI 0.88-1.48). CONCLUSIONS In this observational analysis of T2D and ASCVD, baseline β-blocker use was not associated with risks for severe hypoglycemia yet also was not associated with CV risk reduction over 3 years of follow-up, supporting a randomized examination of chronic β-blocker therapy in this patient population. (TECOS ClinicalTrials.gov number, NCT00790205).
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Affiliation(s)
- Jay S Shavadia
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Division of Cardiology, Department of Medicine, University of Saskatchewan, Saskatchewan, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
| | - Yinggan Zheng
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer B Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | | | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jan H Cornel
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Rury R Holman
- Diabetes Trials Unit, University of Oxford, Oxford, UK
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Kim BS, Eom SY, Kim SH, Hwang HK, Park JS, Kim W, Lee JW, Rha SW, Kim GY, Lim SW, Lee SH, Chae JK, Woo SI, Bae JW, Kim HJ. Effect of Pre-Procedural Beta-Blocker on Clinical Outcome after Percutaneous Coronary Intervention in Acute Coronary Syndrome. Int Heart J 2019; 60:1284-1292. [PMID: 31735782 DOI: 10.1536/ihj.19-175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The efficacy of pre-procedural beta-blocker use in patients with acute coronary syndrome (ACS) is not well established in the current percutaneous coronary intervention (PCI) era. We investigate the effect of pre-procedural beta-blocker use on clinical outcomes in patients with ACS undergoing PCI. Among 44,967 consecutive cases of PCI enrolled in the nationwide, retrospective, multicenter registry (K-PCI registry), 31,040 patients with ACS were selected and analyzed. We classified patients into pre-procedural beta-blocker group (n = 8,678) and pre-procedural no-beta-blocker group (n = 22,362) according to the use of beta-blockers at least for two weeks before index PCI. Propensity score-matching analysis was performed and resulted in 7,445 pairs. The primary outcome was in-hospital cardiac death. In propensity score-matched populations, the pre-procedural beta-blocker group had a lower incidence of in-hospital cardiac death compared with the pre-procedural no-beta-blocker group (1.1% versus 2.0%, unadjusted odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.42-0.73, P < 0.01). In subgroup analysis, the pre-procedural beta-blocker group had a lower incidence of in-hospital cardiac death, compared with the pre-procedural no-beta-blocker group in ST-segment elevation myocardial infarction subpopulation (3.1% versus 6.1%, unadjusted OR: 0.49, 95% CI: 0.34-0.71, P < 0.01) and non-ST-segment elevation myocardial infarction subpopulation (1.5% versus 2.9%, unadjusted OR: 0.51, 95% CI: 0.33-0.79, P < 0.01). However, in unstable angina subpopulation, the in-hospital cardiac death rate was comparable between both groups. In conclusion, the use of pre-procedural beta-blocker was associated with a lower risk of in-hospital cardiac death in patients with ACS undergoing PCI. This result adds to the body of evidence that use of pre-procedural beta-blocker in patients with ACS might be reasonable.
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Affiliation(s)
- Bum Sung Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University
| | - Sang-Youg Eom
- Department of Preventive Medicine, College of Medicine, Chungbuk National University
| | - Sung Hea Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University
| | - Hweung Kon Hwang
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital
| | - Weon Kim
- Cardiovascular Division, Department of Internal Medicine, Kyung Hee University Hospital
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital
| | | | | | | | | | - Jei Keon Chae
- Division of Cardiology, Chonbuk National University Hospital
| | | | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University, College of Medicine
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University
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Liu PY, Chen CL, Yu MC, Ko YL, Hsu SY, Chou HH, Yeh KH, Duan D, Chen MH, Lin JF. Doses of renin-angiotensin system inhibitors but not beta-blockers predict outcome after ST-elevation myocardial infarction. Acta Clin Belg 2019; 74:334-341. [PMID: 30295167 DOI: 10.1080/17843286.2018.1528708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objectives: In patients with ST-elevation myocardial infarction (STEMI), it is not clear whether low-dose renin-angiotensin system inhibitors and beta-blockers can result in the same benefits achievable with higher target doses. This observational study aims to investigate whether higher doses of angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) and beta-blockers can improve outcomes in patients with STEMI. Methods: We recorded daily doses of ACEI, ARB, and beta-blockers in 331 patients with STEMI. Echocardiographic studies were performed at baseline and were repeated 6 months later. Clinical events, including all-cause death and heart failure, were followed for 2 years. Results: Patients receiving high-dose ACEI/ARB had less increase in left ventricular end-diastolic volume index (LVEDVI) at 6 months. In multivariable linear regression model, ACEI/ARB dose or beta-blocker dose was not an independent predictor of increase in LVEDVI at 6 months. Kaplan-Meier survival curves showed that doses of ACEI/ARB (p = 0.003) and beta-blockers (p = 0.027) were significant predictors of death and heart failure. In multivariable Cox regression analysis, independent predictors of all-cause death and heart failure were diabetes mellitus (p = 0.001), left ventricular ejection fraction (p = 0.026), and ACEI/ARB dose (p = 0.025). Beta-blockers dose was not a predictor of clinical events in multivariable analysis (p = 0.413). Conclusion: High-dose ACEI/ARB, but not beta-blocker, was associated with lower rate of all-cause death and heart failure in patients with STEMI.
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Affiliation(s)
- Pei-Yu Liu
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Lin Chen
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Min-Chien Yu
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Lin Ko
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shun-Yi Hsu
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hsin-Hua Chou
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kuan-Hung Yeh
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - De‑Min Duan
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ming-Hsin Chen
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jeng-Feng Lin
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
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Shavadia JS, Holmes DN, Thomas L, Peterson ED, Granger CB, Roe MT, Wang TY. Comparative Effectiveness of β-Blocker Use Beyond 3 Years After Myocardial Infarction and Long-Term Outcomes Among Elderly Patients. Circ Cardiovasc Qual Outcomes 2019; 12:e005103. [DOI: 10.1161/circoutcomes.118.005103] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The benefit of β-blocker use beyond 3 years after a myocardial infarction (MI) has not been clearly determined.
Methods and Results:
Using data from the CRUSADE Registry (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) linked with Medicare claims, we studied patients ≥65 years of age with MI, discharged on β-blocker therapy and alive 3 years later without a recurrent MI to evaluate β-blocker use and dose (none, <50%, and ≥50% of the recommended target) at 3 years. Using inverse probability of treatment weighting, we then examined the adjusted association between β-blocker use (and dose) at 3 years and the cardiovascular composite of all-cause mortality, hospitalization for recurrent MI, ischemic stroke, or heart failure over the subsequent 5 years. Of the 6893 patients ≥65 years age, β-blocker use at 3 years was 72.2% (n=4980); 43% (n=2162) of these were treated with ≥50% of the target β-blocker dose. β-blocker use was not associated with a significant difference on the composite outcome (52.4% versus 55.4%, adjusted hazard ratio, 0.95; 95% CI, 0.88–1.03;
P
=0.23). Neither low dose (<50% target dose) nor high dose (≥50% target dose) β-blocker use was associated with a significant difference in risk when compared with no β-blocker use. Results were also consistent in patients with and without heart failure or systolic dysfunction (
P
interaction =0.30).
Conclusions:
In this observational analysis, β-blocker use beyond 3 years post-MI, regardless of the dose achieved, was not associated with improved outcomes. The role of prolonged β-blocker use, particularly in older adults, needs further investigation.
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Affiliation(s)
- Jay S. Shavadia
- Duke Clinical Research Institute, Durham, NC (J.S.S., D.N.H., L.T., E.D.P., C.B.G., M.T.R., T.Y.W.)
- Division of Cardiology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada (J.S.S.)
| | - DaJuanicia N. Holmes
- Duke Clinical Research Institute, Durham, NC (J.S.S., D.N.H., L.T., E.D.P., C.B.G., M.T.R., T.Y.W.)
| | - Laine Thomas
- Duke Clinical Research Institute, Durham, NC (J.S.S., D.N.H., L.T., E.D.P., C.B.G., M.T.R., T.Y.W.)
| | - Eric D. Peterson
- Duke Clinical Research Institute, Durham, NC (J.S.S., D.N.H., L.T., E.D.P., C.B.G., M.T.R., T.Y.W.)
| | - Christopher B. Granger
- Duke Clinical Research Institute, Durham, NC (J.S.S., D.N.H., L.T., E.D.P., C.B.G., M.T.R., T.Y.W.)
| | - Matthew T. Roe
- Duke Clinical Research Institute, Durham, NC (J.S.S., D.N.H., L.T., E.D.P., C.B.G., M.T.R., T.Y.W.)
| | - Tracy Y. Wang
- Duke Clinical Research Institute, Durham, NC (J.S.S., D.N.H., L.T., E.D.P., C.B.G., M.T.R., T.Y.W.)
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Abstract
Heart disease is the leading cause of death among women in the industrialized world. However, women after myocardial infarctions (MIs) are less likely to receive preventive medications or revascularization and as many as 47% experience heart failure, stroke or die within 5 years. Premenopausal women with MIs frequently have coronary plaque erosions or dissections. Women under 50 years with angina and nonobstructive epicardial coronary artery disease often have coronary microvascular dysfunction (CMD) with reductions in coronary flow reserve that may require nontraditional therapies. In women with coronary artery disease treated with stents, the 3-year incidence of recurrent MI or death is 9.2%. Coronary bypass surgery operative mortality averages 4.6% for women compared with 2.4% in men. Addition of internal mammary artery and radial artery coronary grafts in women does not increase operative survival but improves 5-year outcome to greater than 80%.
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Okuno T, Aoki J, Tanabe K, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Yasuda S, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Mano T, Hirata K, Shibata Y, Owa M, Tsujita K, Funayama H, Kokubu N, Kozuma K, Uemura S, Tobaru T, Saku K, Ohshima S, Nishimura K, Miyamoto Y, Ogawa H, Ishihara M. Admission Heart Rate Is a Determinant of Effectiveness of Beta-Blockers in Acute Myocardial Infarction Patients. Circ J 2019; 83:1054-1063. [PMID: 30930346 DOI: 10.1253/circj.cj-18-0995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Beta-blockers are standard therapy for acute myocardial infarction (AMI). However, despite current advances in the management of AMI, it remains unclear whether all AMI patients benefit from β-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of β-blockers for AMI patients. Methods and Results: We enrolled 3,283 consecutive AMI patients who were admitted to 28 participating institutions in the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) study. According to admission HR, we divided patients into 3 groups: bradycardia (HR <60 beats/min, n=444), normocardia (HR 60 to ≤100 beats/min, n=2,013), and tachycardia (HR >100 beats/min, n=342). The primary endpoint was major adverse cardiac events (MACE), including all-cause death, non-fatal MI, non-fatal stroke, heart failure (HF), and urgent revascularization for unstable angina, at 3-year follow-up. Beta-blocker at discharge was significantly associated with a lower risk of MACE in the tachycardia group (23.6% vs. 33.0%; P=0.033), but it did not affect rates of MACE in the normocardia group (17.8% vs. 18.4%; P=0.681). In the bradycardia group, β-blocker use at discharge was significantly associated with a higher risk of MACE (21.6% vs. 12.7%; P=0.026). Results were consistent for multivariable regression and stepwise multivariable regression. CONCLUSIONS Admission HR might determine the efficacy of β-blockers for current AMI patients.
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Affiliation(s)
- Taishi Okuno
- Division of Cardiology, Mitsui Memorial Hospital
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamoto Medical Center
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University
| | - Atsushi Hirohata
- Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama
| | | | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | | | | | - Kazuhito Hirata
- Department of Cardiology, Okinawa Prefectural Chubu Hospital
| | | | - Mafumi Owa
- Department of Cardiovascular Medicine, Suwa Red Cross Hospital
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Hiroshi Funayama
- Division of Cardiovascular Medicine, Saitama Medical Center Jichi Medical University
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical School
| | - Ken Kozuma
- Department of Cardiology, Teikyo University
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | | | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
| | - Shigeru Ohshima
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kunihiro Nishimura
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
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Dahl Aarvik M, Sandven I, Dondo TB, Gale CP, Ruddox V, Munkhaugen J, Atar D, Otterstad JE. Effect of oral β-blocker treatment on mortality in contemporary post-myocardial infarction patients: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 5:12-20. [PMID: 30192930 PMCID: PMC6321955 DOI: 10.1093/ehjcvp/pvy034] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/02/2018] [Indexed: 12/28/2022]
Abstract
Aims Guidelines concerning β-blocker treatment following acute myocardial infarction (AMI) are based on studies undertaken before the implementation of reperfusion and secondary prevention therapies. We aimed to estimate the effect of oral β-blockers on mortality in contemporary post-AMI patients with low prevalence of heart failure and/or reduced left ventricular ejection fraction. Methods and results A random effects model was used to synthetize results of 16 observational studies published between 1 January 2000 and 30 October 2017. Publication bias was evaluated, and heterogeneity between studies examined by subgroup and random effects meta-regression analyses considering patient-related and study-level variables. The pooled estimate showed that β-blocker treatment [among 164 408 (86.8%) patients, with median follow-up time of 2.7 years] was associated with a 26% reduction in all-cause mortality [rate ratio (RR) 0.74, 95% confidence interval (CI) 0.64–0.85] with moderate heterogeneity (I2 = 67.4%). The patient-level variable mean age of the cohort explained 31.5% of between study heterogeneity. There was presence of publication bias, or small study effect, and when controlling for bias by the trim and fill simulation method, the effect disappeared (adjusted RR 0.90, 95% CI 0.77–1.04). Also, small study effect was demonstrated by a cumulative meta-analysis starting with the largest study showing no effect, with increasing effect as the smaller studies were accumulated. Conclusion Evidence from this study suggests that there is no association between β-blockers and all-cause mortality. A possible beneficial effect in AMI survivors needs to be tested by large randomized clinical trials.
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Affiliation(s)
- Magnus Dahl Aarvik
- Institute of Clinical Sciences, University of Oslo, Sognsvannsveien 9, Oslo, Norway
| | - Irene Sandven
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Sogn Arena, Nydalen, Oslo, Norway
| | - Tatendashe B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicince, Clarendon Way, University of Leeds, Leeds, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicince, Clarendon Way, University of Leeds, Leeds, UK
| | - Vidar Ruddox
- Department of Cardiology, Vestfold Hospital Trust, N-3103 Toensberg, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Wergelandsgate 10, Drammen, Norway
| | - Dan Atar
- Institute of Clinical Sciences, University of Oslo, Sognsvannsveien 9, Oslo, Norway.,Department of Cardiology B, Oslo University Hospital, Ullevaal, Kirkeveien 166, Oslo, Norway
| | - Jan Erik Otterstad
- Department of Cardiology, Vestfold Hospital Trust, N-3103 Toensberg, Norway
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Peyracchia M, Errigo D, Raposeiras Rubin S, Conrotto F, DiNicolantonio JJ, Omedè P, Rettegno S, Iannaccone M, Moretti C, D'Amico M, Gaita F, D'Ascenzo F. Beta-blocker therapy reduces mortality in patients with coronary artery disease treated with percutaneous revascularization: a meta-analysis of adjusted results. J Cardiovasc Med (Hagerstown) 2019; 19:337-343. [PMID: 29877974 DOI: 10.2459/jcm.0000000000000662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS The long-term impact of beta blockers on prognosis in patients treated with contemporary therapies for coronary artery disease remains to be defined. METHODS AND RESULTS All observational studies evaluating the impact of beta blockers in patients treated with coronary revascularization and contemporary therapies and adjusted with multivariate analysis were included. All-cause death was the primary endpoint, while Major Adverse Cardiac Events (MACE) (composite endpoint of all-cause death or myocardial infarction, MI) and MI were secondary endpoints. A total of 26 studies were included, with 863 335 patients. After 3 (1-4.3) years, long-term risk of all-cause death was lower in patients on beta blockers [odds ratio, OR 0.69 (0.66-0.72)], both for Acute Coronary Syndrome (ACS) [OR 0.60 (0.56-0.65)], and stable angina patients [OR 0.84 (0.78-0.91)], independently from ejection fraction [OR 0.64 (0.42-0.98) for reduced ejection fraction and OR 0.79 (0.69-0.91) for preserved ejection fraction]. The risk of long-term MACE was lower but NS for ACS patients treated with beta blockers [OR 0.83 (0.69-1.00)], as in stable angina. Similarly, risk of MI did not differ between patients treated with beta blockers or without beta blockers [OR 0.99 (0.89-1.09), all 95% confidence intervals]. Using meta-regression analysis, the benefit of beta blockers was increased for those with longer follow-up. The number needed to treat was 52 to avoid one event of all-cause death for ACS patients and 111 for stable patients. CONCLUSION Even in percutaneous coronary intervention era, beta blockers reduce mortality in patients with coronary artery disease, confirming their protective effect, which was consistent for both ACS and stable patients indifferently of preserved or reduced ejection fraction.
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Affiliation(s)
- Mattia Peyracchia
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Daniele Errigo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Sergio Raposeiras Rubin
- Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, Spain
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | | | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Sara Rettegno
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Mario Iannaccone
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
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Affiliation(s)
- Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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Ferreira D. The dilemma of beta-blocker use after acute coronary syndrome: To support the dogma or to embrace the paradigm shift? Rev Port Cardiol 2018; 37:909-910. [PMID: 30449611 DOI: 10.1016/j.repc.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Daniel Ferreira
- Cardiovascular Centre, Hospital da Luz Lisboa, Lisbon, Portugal.
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40
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The dilemma of beta-blocker use after acute coronary syndrome: To support the dogma or to embrace the paradigm shift? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Watanabe H, Ozasa N, Morimoto T, Shiomi H, Bingyuan B, Suwa S, Nakagawa Y, Izumi C, Kadota K, Ikeguchi S, Hibi K, Furukawa Y, Kaji S, Suzuki T, Akao M, Inada T, Hayashi Y, Nanasato M, Okutsu M, Kametani R, Sone T, Sugimura Y, Kawai K, Abe M, Kaneko H, Nakamura S, Kimura T. Long-term use of carvedilol in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. PLoS One 2018; 13:e0199347. [PMID: 30153268 PMCID: PMC6112626 DOI: 10.1371/journal.pone.0199347] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite its recommendation by the current guidelines, the role of long-term oral beta-blocker therapy has never been evaluated by randomized trials in uncomplicated ST-segment elevation myocardial infarction (STEMI) patients without heart failure, left ventricular dysfunction or ventricular arrhythmia who underwent primary percutaneous coronary intervention (PCI). METHODS AND RESULTS In a multi-center, open-label, randomized controlled trial, STEMI patients with successful primary PCI within 24 hours from the onset and with left ventricular ejection fraction (LVEF) ≥40% were randomly assigned in a 1-to-1 fashion either to the carvedilol group or to the no beta-blocker group within 7 days after primary PCI. The primary endpoint is a composite of all-cause death, myocardial infarction, hospitalization for heart failure, and hospitalization for acute coronary syndrome. Between August 2010 and May 2014, 801 patients were randomly assigned to the carvedilol group (N = 399) or the no beta-blocker group (N = 402) at 67 centers in Japan. The carvedilol dose was up-titrated from 3.4±2.1 mg at baseline to 6.3±4.3 mg at 1-year. During median follow-up of 3.9 years with 96.4% follow-up, the cumulative 3-year incidences of both the primary endpoint and any coronary revascularization were not significantly different between the carvedilol and no beta-blocker groups (6.8% and 7.9%, P = 0.20, and 20.3% and 17.7%, P = 0.65, respectively). There also was no significant difference in LVEF at 1-year between the 2 groups (60.9±8.4% and 59.6±8.8%, P = 0.06). CONCLUSION Long-term carvedilol therapy added on the contemporary evidence-based medications did not seem beneficial in selected STEMI patients treated with primary PCI. TRIAL REGISTRATION CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in Large-scale Randomized Controlled Trial) ClinicalTrials.gov.number, NCT 01155635.
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Affiliation(s)
- Hiroki Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bao Bingyuan
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Suwa
- Division of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | | | | | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shuichiro Kaji
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takahiko Suzuki
- Division of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tsukasa Inada
- Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Yasuhiko Hayashi
- Division of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Mamoru Nanasato
- Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Masaaki Okutsu
- Division of Cardiology, Nozaki Tokushukai Hospital, Osaka, Japan
| | - Ryosuke Kametani
- Division of Cardiology, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Takahito Sone
- Division of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yoichi Sugimura
- Division of Cardiology, Kawakita General Hospital, Tokyo, Japan
| | - Kazuya Kawai
- Division of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Mitsunori Abe
- Division of Cardiology, Yotsuba Circulation Clinic, Matsuyama, Japan
| | - Hironori Kaneko
- Division of Cardiology, Hoshi General Hospital, Koriyama, Japan
| | - Sunao Nakamura
- Division of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
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Hong J, Barry AR. Long-Term Beta-Blocker Therapy after Myocardial Infarction in the Reperfusion Era: A Systematic Review. Pharmacotherapy 2018; 38:546-554. [DOI: 10.1002/phar.2110] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jenny Hong
- Faculty of Pharmaceutical Sciences; University of British Columbia; Vancouver British Columbia Canada
| | - Arden R. Barry
- Faculty of Pharmaceutical Sciences; University of British Columbia; Vancouver British Columbia Canada
- Chilliwack General Hospital; Lower Mainland Pharmacy Services; Chilliwack British Columbia Canada
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Lee DS, Lee MY, Park CM, Kim DI, Kim YW, Park YJ. Preoperative statins are associated with a reduced risk of postoperative delirium following vascular surgery. PLoS One 2018; 13:e0192841. [PMID: 29570715 PMCID: PMC5865715 DOI: 10.1371/journal.pone.0192841] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/31/2018] [Indexed: 12/13/2022] Open
Abstract
Delirium is a common complication of vascular surgery. The protective effect of preoperative statins on delirium after vascular surgery is controversial. The authors hypothesized that preoperative statin administration would decrease the incidence of delirium after vascular surgery. From May 2010 to May 2015, 1,132 patients underwent vascular surgery. Postoperative delirium was diagnosed from patients’ medical records. The incidence of delirium was 11.5%. The preoperative statin exposure was not associated with reduced delirium in the univariate analysis. After adjusting for covariates, preoperative statin exposure was associated with reduced delirium (OR, 0.54; 95% CI, 0.33–0.87; p = 0.011). This favor effect of statin for delirium was observed after propensity matching (OR, 0.59; 95% CI, 0.34–1.02; p = 0.060). However, the median hospital lengths of stay and in-hospital mortality were not statistically different between the two groups. CRP(C-reactive protein) levels in the unmatched population were lower in the preoperative statin group compared with the other group (p<0.001), however, there was only numerically different without statistical difference after matching (p = 0.083). Preoperative statin use was associated with a decreased incidence of postoperative delirium in patients who underwent vascular surgery. However, preoperative statin did not reduce mortality rate and hospital stay.
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Affiliation(s)
- Dae-Sang Lee
- Department of Trauma Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Yeon Lee
- Department of Biostatistics, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Ik Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Wook Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang-Jin Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Park JJ, Kim SH, Kang SH, Yoon CH, Cho YS, Youn TJ, Chae IH, Choi DJ. Effect of β-Blockers Beyond 3 Years After Acute Myocardial Infarction. J Am Heart Assoc 2018; 7:JAHA.117.007567. [PMID: 29502101 PMCID: PMC5866322 DOI: 10.1161/jaha.117.007567] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The optimal duration of β‐blocker therapy in patients with acute myocardial infarction (AMI) is unknown. We aimed to evaluate the late effect of β‐blockers in patients with AMI. Methods and Results We enrolled all consecutive patients who presented with AMI at Seoul National University Bundang Hospital, between June 3, 2003 and February 24, 2015. The primary end point was 5‐year all‐cause mortality, depending on the use of β‐blockers at discharge, 1 year after AMI, and 3 years after AMI. Of 2592 patients, the prescription rates of β‐blockers were 72%, 69%, 63%, and 60% at discharge and 1, 3, and 5 years after AMI, respectively. The patients who were receiving β‐blocker therapy had more favorable clinical characteristics, such as younger age (62 versus 65 years; P<0.001). They received reperfusion therapy more often (92% versus 80%; P<0.001) than those without β‐blocker prescription. In the univariate analysis, the patients with β‐blocker prescription had lower 5‐year mortality at all time points. In the Cox model after adjustment for significant covariates, β‐blocker prescription at discharge was associated with a 29% reduced mortality risk (hazard ratio, 0.71; 95% confidence interval, 0.55–0.90; P=0.006); however, β‐blocker prescriptions at 1 and 3 years after AMI were not associated with reduced mortality. Conclusions The beneficial effect of β‐blocker therapy after AMI may be limited until 1 year after AMI. Whether late β‐blocker therapy beyond 1 year after AMI offers clinical benefits should be confirmed in further clinical trials.
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Affiliation(s)
- Jin Joo Park
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun-Hwa Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Seok Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Jin Youn
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Ju Choi
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Weir MA, Herzog CA. Beta blockers in patients with end-stage renal disease-Evidence-based recommendations. Semin Dial 2018; 31:219-225. [PMID: 29482260 DOI: 10.1111/sdi.12691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular sequelae. However, the evidence supporting their use in patients receiving hemodialysis is sparse and the heterogeneity of the beta blocker class makes it difficult to prescribe these medications with confidence. Despite these limitations, both trial and observational data exist that can help guide the use of these medications. In this review, we outline the reasons to consider beta blockers for patients receiving hemodialysis, discuss the barriers to their use, and provide specific evidence-based recommendations for beta blocker use in patients with heart failure, hypertension, ischemic heart disease and arrhythmia.
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Affiliation(s)
- Matthew A Weir
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA.,Division of Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
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Andreasen C, Andersson C. Current use of beta-blockers in patients with coronary artery disease. Trends Cardiovasc Med 2018; 28:382-389. [PMID: 29373178 DOI: 10.1016/j.tcm.2017.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/13/2017] [Accepted: 12/29/2017] [Indexed: 12/13/2022]
Abstract
Beta-blockers have long comprised a cornerstone in the symptomatic treatment of ischemic heart disease and in the secondary prevention of myocardial infarction and heart failure. The majority of studies underlying the evidence of a beneficial effect of beta-blockers on outcomes were conducted more than 25 years ago. In a contemporary era where treatment strategies and secondary prophylactic therapy have undergone several changes, the continued role of beta-blockers in ischemic heart disease has been questioned, especially in the absence of heart failure or a recent myocardial infarction. In summary, few randomized clinical trials are available on the effect of beta-blockers in the reperfusion era, especially on hard endpoints. Likewise, the results of numerous observational studies and meta-analysis are conflicting, emphasizing the need for additional large-scale randomized clinical trials to evaluate the role of beta-blocker therapy in current clinical practice.
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Chung J, Han JK, Kim YJ, Kim CJ, Ahn Y, Chan Cho M, Chae SC, Chae IH, Chae JK, Seong IW, Yang HM, Park KW, Kang HJ, Koo BK, Jeong MH, Kim HS. Benefit of Vasodilating β-Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study. J Am Heart Assoc 2017; 6:e007063. [PMID: 29066446 PMCID: PMC5721887 DOI: 10.1161/jaha.117.007063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/11/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although current guidelines recommend β-blocker after acute myocardial infarction (MI), the role of β-blocker has not been well investigated in the modern reperfusion era. In particular, the benefit of vasodilating β-blocker over conventional β-blocker is still unexplored. METHODS AND RESULTS Using nation-wide multicenter Korean Acute Myocardial Infarction Registry data, we analyzed clinical outcomes of 7127 patients with acute MI who underwent successful percutaneous coronary intervention with stents and took β-blockers: vasodilating β-blocker (n=3482), and conventional β-blocker (n=3645). In the whole population, incidence of cardiac death at 1 year was significantly lower in the vasodilating β-blocker group (vasodilating β-blockers versus conventional β-blockers, 1.0% versus 1.9%; P=0.003). In 2882 pairs of propensity score-matched population, the incidence of cardiac death was significantly lower in the vasodilating β-blocker group (1.1% versus 1.8%; P=0.028). Although incidences of MI (1.1% versus 1.5%; P=0.277), any revascularization (2.8% versus 3.0%; P=0.791), and hospitalization for heart failure (1.4% versus 1.9%; P=0.210) were not different between the 2 groups, incidences of cardiac death or MI (2.0% versus 3.1%; P=0.010), cardiac death, MI, or hospitalization for heart failure (3.0% versus 4.5%; P=0.003), cardiac death, MI, or any revascularization (3.9% versus 5.3%; P=0.026), and cardiac death, MI, any revascularization, or hospitalization for heart failure (4.8% versus 6.5%; P=0.011) were significantly lower in the vasodilating β-blocker group. CONCLUSIONS Vasodilating β-blocker therapy resulted in better clinical outcomes than conventional β-blocker therapy did in patients with acute MI in the modern reperfusion era. Vasodilating β-blockers could be recommended preferentially to conventional ones for acute MI patients.
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Affiliation(s)
- Jaehoon Chung
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung-Kyu Han
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyunghee University Hospital, Seoul, Korea
| | - Youngkeun Ahn
- Department of Internal Medicine, Chonnam National University Hospital, Kwangju, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hosptial, Daegu, Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Jei Keon Chae
- Department of Cardiovascular Medicine, Medical School of Chonbuk National University, Jeonju, Korea
| | - In-Whan Seong
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Han-Mo Yang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Woo Park
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Kwangju, Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Sim DS, Jeong MH. Differences in the Korea Acute Myocardial Infarction Registry Compared with Western Registries. Korean Circ J 2017; 47:811-822. [PMID: 29035427 PMCID: PMC5711672 DOI: 10.4070/kcj.2017.0027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/14/2017] [Accepted: 05/31/2017] [Indexed: 01/26/2023] Open
Abstract
The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry that reflects current therapeutic approaches and acute myocardial infarction (AMI) management in Korea. The results of the KAMIR demonstrated different risk factors and responses to medical and interventional treatments. The results indicated that the incidence of ST-elevation myocardial infarction (STEMI) was relatively high, and that the prevalence of dyslipidemia was relatively low with higher triglyceride and lower high-density lipoprotein cholesterol levels. Percutaneous coronary intervention (PCI) rates were high for both STEMI and non-ST-elevation myocardial infarction (NSTEMI) with higher use of drug-eluting stents (DESs). DES were effective and safe without increased risk of stent thrombosis in Korean AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel, and cilostazol, was effective in preventing adverse clinical outcomes after PCI. Statin therapy was effective in Korean AMI patients, including those with very low levels of low-density lipoprotein cholesterol and those with cardiogenic shock. The KAMIR score had a greater predictive value than Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores for long-term mortality in AMI patients. Based on these results, the KAMIR will be instrumental for establishing new therapeutic strategies and effective methods for secondary prevention of AMI and guidelines for Asian patients.
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Affiliation(s)
- Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea.
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50
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García-García C, Ribas N, Recasens LL, Meroño O, Subirana I, Fernández A, Pérez A, Miranda F, Tizón-Marcos H, Martí-Almor J, Bruguera J, Elosua R. In-hospital prognosis and long-term mortality of STEMI in a reperfusion network. "Head to head" analisys: invasive reperfusion vs optimal medical therapy. BMC Cardiovasc Disord 2017; 17:139. [PMID: 28549452 PMCID: PMC5446735 DOI: 10.1186/s12872-017-0574-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/18/2017] [Indexed: 01/15/2023] Open
Abstract
Background ST Segment Elevation Acute myocardial infarction (STEMI) preferred treatment is culprit artery reperfusion with primary percutaneous coronary intervention (PPCI). We ought to analyze the benefit of early reperfusion vs. optimal medical therapy in STEMI before and after the set-up of a regional STEMI network that prioritizes PPCI. Methods Between January 2002 and December 2013, 1268 STEMI patients were consecutively admitted in a University Hospital. Patients were classified in two groups: pre-STEMI Network (January 2002–June 2009; n = 670) and post-STEMI network (July 2009–December 2013; n = 598). Vital status was available at 2-year follow-up. Results The STEMI network increased reperfusion (89.2% vs 64.4%, p < 0.001) mainly using PCI (99.0% vs 43.9%, p < 0.001). In univariate analysis, in-hospital mortality was significantly lower in the post-STEMI network period (2.51% vs. 7.16%, p < 0.001). After multivariate adjustment, including age, sex, comorbidities, severity and reperfusion therapy, a trend to a lower in-hospital mortality was observed (post-Network OR: 0.50, 95% CI:0.16–1.59, p = 0.24); this trend disappeared when optimal medical therapy was included in the model (post-Network OR: 1.14, 95% CI:0.32–4.08, p = 0.840). No differences in 2-year mortality were observed (post-Network HR: 0.83; CI 95%: 0.55–1.25, p = 0.37). Conclusion A STEMI network with PPCI 24/7 improved reperfusion therapy, resulting in an increase on PPCI. Despite in-hospital mortality decreased with a STEMI network, 2-year mortality remained similar in both periods, pre- and post-Network. Optimal medical therapy could be as important as reperfusion therapy in a STEMI reperfusion network.
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Affiliation(s)
- C García-García
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain. .,Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Spain. .,CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
| | - N Ribas
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain.,Ph Program in Internal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - L L Recasens
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - O Meroño
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - I Subirana
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain
| | - A Fernández
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain
| | - A Pérez
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain
| | - F Miranda
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain
| | - H Tizón-Marcos
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J Martí-Almor
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J Bruguera
- Cardiology Department, Hospital del Mar, Parc de Salut Mar-IMIM, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - R Elosua
- Ph Program in Internal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain
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