Long-term β-blocker therapy and clinical outcomes after acute myocardial infarction in patients without heart failure: nationwide cohort study

被引:60
|
作者
Kim, Jihoon [1 ]
Kang, Danbee [2 ,3 ]
Park, Hyejeong [2 ]
Kang, Minwoong [2 ,3 ]
Park, Taek Kyu [1 ]
Lee, Joo Myung [1 ]
Yang, Jeong Hoon [1 ]
Bin Song, Young [1 ]
Choi, Jin-Ho [1 ]
Choi, Seung-Hyuk [1 ]
Gwon, Hyeon-Cheol [1 ]
Guallar, Eliseo [2 ,3 ,4 ,5 ]
Cho, Juhee [2 ,3 ]
Hahn, Joo-Yong [1 ]
机构
[1] Sungkyunkwan Univ, Samsung Med Ctr, Dept Med, Div Cardiol,Sch Med, 81 Irwon Ro, Seoul 06351, South Korea
[2] Sungkyunkwan Univ, Ctr Clin Epidemiol, Samsung Med Ctr, Sch Med, 81 Irwon Ro, Seoul 06351, South Korea
[3] Sungkyunkwan Univ, Dept Clin Res Design & Evaluat, SAIHST, 81 Irwon Ro, Seoul 06351, South Korea
[4] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Welch Ctr Prevent Epidemiol & Clin Res, 615 N Wolfe St, Baltimore, MD 21205 USA
[5] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Med, Welch Ctr Prevent Epidemiol & Clin Res, 615 N Wolfe St, Baltimore, MD 21205 USA
关键词
Myocardial infarction; beta-blocker; Outcomes; ST-SEGMENT-ELEVATION; TASK-FORCE; SURVIVAL; ASSOCIATION; GUIDELINES; METOPROLOL; MANAGEMENT; MORTALITY; ESC;
D O I
10.1093/eurheartj/ehaa376
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims To investigate the association between Long-term beta-blocker therapy and clinical outcomes in patients without heart failure (HF) after acute myocardial infarction (AMI). Methods and results Between 2010 and 2015, a total of 28 970 patients who underwent coronary revascularization for AMI with beta-blacker 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 beta-blacker therapy for >= 1 year (N = 22 707) and beta-blocker therapy for <1 year (N = 6263) using landmark analysis at 1 year after index MI. Compared with patients receiving beta-blacker therapy for <1 year, those receiving beta-blacker 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 beta-blacker 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, beta-btocker therapy for >= 1 year after MI was associated with reduced all-cause death among patients with AMI without HF.
引用
收藏
页码:3521 / 3529
页数:9
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