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

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.

Long-Term Beta-Blocker Therapy After Myocardial Infarction Without Heart Failure in the Reperfusion Era—Systemic Review and Meta-analysis

“…6,7 Moreover, 2 recent large nationwide studies of long-term beta-blockers in patients without heart failure (HF) showed different results. 8,9 Therefore, in the present study, we sought to investigate the association between long-term (≥1 year) beta-blocker therapy and mortality after acute MI in patients without HF.…”

Benefit and risk of prolonged dual antiplatelet therapy after drug-eluting stent implantation in patients with chronic kidney disease: a nationwide cohort study

“…DAPT is considered to be continued if a patient has been prescribed aspirin and P2Y 12 inhibitors including clopidogrel, prasugrel, or ticagrelor without discontinuation for > 7 days. The duration of DAPT was identi ed using prescription data with Korean Drug and Anatomical Therapeutic Chemical codes [11]. Diabetes mellitus was de ned as prescription of oral hypoglycemic agent or insulin.…”

“…Cardiovascular death was identi ed by a death certi cate with at least one cardiovascular diagnosis (acute MI, stroke, heart failure, or sudden cardiac death). 11 MI was de ned by the ICD-10 codes corresponding to acute MI [7] and one or more of the following conditions: (1) concurrent presence of claims for coronary angiography, (2) admission via the emergency department, or (3) performance of cardiac biomarker assessment more than 4 times. Validity of MI was described in Supplementary Method.…”

Qishen Granule (QSG) Inhibits Monocytes Released From the Spleen and Protect Myocardial Function via the TLR4-MyD88-NF-κB p65 Pathway in Heart Failure Mice

“…Myocardial infarction is one of the most common and important causes of heart failure (HF). Accumulating evidence showed that post-infarction HF could increase the risk of short- and long-term adverse events in patients with the rising incidence ( Bahit et al, 2018 ; Kim et al, 2020 ). Although significant progress has been made in the treatment of HF in recent years, the quality of life of patients with HF is still unsatisfying ( Willerson, 2019 ; Baman and Ahmad, 2020 ).…”