Admission Heart Rate Is a Determinant of Effectiveness of Beta-Blockers in Acute Myocardial Infarction Patients

被引:8
|
作者
Okuno, Taishi [1 ]
Aoki, Jiro [1 ]
Tanabe, Kengo [1 ]
Nakao, Koichi [2 ]
Ozaki, Yukio [3 ]
Kimura, Kazuo [4 ]
Ako, Junya [5 ]
Noguchi, Teruo [6 ]
Yasuda, Satoshi [6 ]
Suwa, Satoru [8 ]
Fujimoto, Kazuteru [9 ]
Nakama, Yasuharu [10 ]
Morita, Takashi [11 ]
Shimizu, Wataru [12 ]
Saito, Yoshihiko [13 ]
Hirohata, Atsushi [14 ]
Morita, Yasuhiro [15 ]
Inoue, Teruo [16 ]
Okamura, Atsunori [17 ]
Mano, Toshiaki [18 ]
Hirata, Kazuhito [19 ]
Shibata, Yoshisato [20 ]
Owa, Mafumi [21 ]
Tsujita, Kenichi [22 ]
Funayama, Hiroshi [23 ]
Kokubu, Nobuaki [24 ]
Kozuma, Ken [25 ]
Uemura, Shiro [26 ]
Tobaru, Tetsuya [27 ]
Saku, Keijiro [28 ]
Ohshima, Shigeru [29 ]
Nishimura, Kunihiro [7 ]
Miyamoto, Yoshihiro [7 ]
Ogawa, Hisao [30 ]
Ishihara, Masaharu [31 ]
机构
[1] Mitsui Mem Hosp, Div Cardiol, Tokyo, Japan
[2] Saiseikai Kumamoto Hosp, Ctr Cardiovasc, Div Cardiol, Kumamoto, Japan
[3] Fujita Hlth Univ Hosp, Dept Cardiol, Toyoake, Aichi, Japan
[4] Yokohama City Univ, Med Ctr, Ctr Cardiovasc, Yokohama, Kanagawa, Japan
[5] Kitasato Univ, Dept Cardiovasc Med, Sagamihara, Kanagawa, Japan
[6] Natl Cerebral & Cardiovasc Ctr, Dept Cardiovasc Med, Suita, Osaka, Japan
[7] Natl Cerebral & Cardiovasc Ctr, Dept Prevent Cardiol, Suita, Osaka, Japan
[8] Juntendo Univ, Shizuoka Hosp, Dept Cardiol, Shizuoka, Japan
[9] Natl Hosp Org Kumamoto Med Ctr, Dept Cardiol, Kumamoto, Japan
[10] Hiroshima City Hosp, Dept Cardiol, Hiroshima, Japan
[11] Osaka Gen Med Ctr, Div Cardiol, Osaka, Japan
[12] Nippon Med Sch, Dept Cardiovasc Med, Tokyo, Japan
[13] Nara Med Univ, Dept Internal Med 1, Kashihara, Nara, Japan
[14] Sakakibara Heart Inst Okayama, Dept Cardiovasc Med, Okayama, Japan
[15] Ogaki Municipal Hosp, Dept Cardiol, Ogaki, Japan
[16] Dokkyo Med Univ, Dept Cardiovasc Med, Mibu, Tochigi, Japan
[17] Sakurabashi Watanabe Hosp, Dept Cardiol, Osaka, Japan
[18] Kansai Rosai Hosp, Ctr Cardiovasc, Amagasaki, Hyogo, Japan
[19] Okinawa Prefectural Chubu Hosp, Dept Cardiol, Uruma, Japan
[20] Miyazaki Med Assoc Hosp, Dept Cardiol, Miyazaki, Japan
[21] Suwa Red Cross Hosp, Dept Cardiovasc Med, Suwa, Japan
[22] Kumamoto Univ, Grad Sch Med Sci, Dept Cardiovasc Med, Kumamoto, Japan
[23] Jichi Med Univ, Saitama Med Ctr, Div Cardiovasc Med, Saitama, Japan
[24] Sapporo Med Sch, Dept Cardiovasc Renal & Metab Med, Sapporo, Hokkaido, Japan
[25] Teikyo Univ, Dept Cardiol, Tokyo, Japan
[26] Kawasaki Med Sch, Dept Cardiol, Kurashiki, Okayama, Japan
[27] Sakakibara Heart Inst, Dept Cardiol, Tokyo, Japan
[28] Fukuoka Univ, Sch Med, Dept Cardiol, Fukuoka, Fukuoka, Japan
[29] Gunma Prefectural Cardiovasc Ctr, Dept Cardiol, Maebashi, Gunma, Japan
[30] Natl Cerebral & Cardiovasc Ctr, Suita, Osaka, Japan
[31] Hyogo Coll Med, Div Coronary Artery Dis, Nishinomiya, Hyogo, Japan
关键词
Acute myocardial infarction; Beta-blockers; Heart rate; ST-SEGMENT ELEVATION; PERCUTANEOUS CORONARY INTERVENTION; CLINICAL-OUTCOMES; RANDOMIZED-TRIAL; EUROPEAN-SOCIETY; MORTALITY; THERAPY; DISCHARGE; BLOCKADE; METAANALYSIS;
D O I
10.1253/circj.CJ-18-0995
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 beta-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of beta-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, beta-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 beta-blockers for current AMI patients.
引用
收藏
页码:1054 / +
页数:14
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