A substantial number of patients are still not offered any reperfusion therapy in many Eastern European countries with economy in transition, and this was associated with increased 30-day mortality. Time from symptoms onset to admission >12 h was the highest ranking among factors related to lack of reperfusion therapy. Quality improvement efforts should focus on minimizing delay to hospital admission among STEMI patients.
The aim of this study was to determine if earlier administration of oral beta-blocker therapy in patients with acute coronary syndromes (ACSs) is associated with increased short-term survival and improved left ventricular (LV) function. We studied 11,581 patients enrolled in the International Survey of Acute Coronary Syndromes in Transitional Countries ( ISACS-TC) registry from January 2010 to June 2014. Of these patients, 6,117 were excluded as they received intravenous beta-blockers or remained free of any beta-blocker treatment during hospital stay, 23 with unknown timing of oral beta-blocker administration was unknown and 182 because they had death before oral beta-blockers could be given. The final study population comprised 5,259 patients. The primary outcome was the incidence of in-hospital mortality. The secondary outcome was the incidence of severe LV dysfunction defined as an ejection fraction <40% at hospital discharge. Oral beta-blockers were administered soon (≤24 hours) after hospital admission in 1,377 patients and later (>24 hours) during hospital stay in the remaining 3,882 patients. Early beta-blocker therapy was significantly associated with reduced in-hospital mortality (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.21 to 0.80) and reduced incidence of severe LV dysfunction (OR 0.57, 95% CI 0.42 to 0.78). Significant mortality benefits with early beta-blocker therapy disappeared when patients with Killip Class III/IV were included as dummy variables. The results were confirmed by propensity score-matched analyses.In conclusion, in patients with ACSs, earlier administration of oral beta-blocker therapy should be a priority with a higher probability of improving LV function and in-hospital survival. Patients presenting with acute pulmonary edema or cardiogenic shock should be excluded from this early treatment regimen.Key Words: Acute Coronary Syndrome; Beta-Blockers; Timing; In-hospital mortality.
3There is a general consensus that pre-discharge oral beta-blocker therapy leads to improved longterm clinical outcome in patients with acute coronary syndromes (ACSs) although, within the framework of an in-hospital treatment strategy, there is a paucity of data on precisely defining when beta-blockers should be started. The most recent practice guidelines from the American College of Cardiology (ACC)/American Heart Association (AHA) recommend that oral betablocker therapy should be given in the first 24 hours if patients are at low risk for cardiogenic shock [1,2]. Risk of cardiogenic shock, in turn, is based on findings from the COMMIT/CCS-2 (Chinese Clopidogrel and Metoprolol in Myocardial Infarction Trial) study [3]. American recommendation is not reflected by the practice guidelines of the European Society of Cardiology (ESC) where decisions on whether to give beta-blocker therapy within 24 hours from admission or several days later are left at physicians' discretion [4,5]. When solid evidence exists, guidelines tend to put forward largely overlapping recommendations. Furthe...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.