Meta-Analysis of Relation Between Oral β-Blocker Therapy and Outcomes in Patients With Acute Myocardial Infarction Who Underwent Percutaneous Coronary Intervention

Huang, Bao‐Tao; Huang, Fang‐Yang; Zuo, Zhi‐Liang; Liao, Yanbiao; Heng, Yue; Wang, Pengju; Gui, Yi‐Yue; Xia, Tianli; Xin, Zhe-Mei; Liu, Wei; Zhang, Chen; Chen, Shijian; Pu, Xiaobo; Chen, Mao; Huang, Dejia

doi:10.1016/j.amjcard.2015.02.057

Cited by 70 publications

(45 citation statements)

References 26 publications

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“…Although this study by Dondo et al has a limitation that almost 95% of the study subjects had received BB, which likely affected the results as a medication bias even after the state-of the art statistical analysis, their findings were consistent with recent analyses (16)(17)(18)(19) and likely true in the contemporary PCI era.…”

supporting

confidence: 78%

“…Ozasa et al also reported a similar finding from the J-Cypher Registry that BB was not associated with better 3-year clinical outcomes in 910 STEMI patients who underwent PCI within 24 hours from the onset (18). Furthermore, a recent meta-analysis comprising 16,645 patients without LVSD and received percutaneous PCI for AMI did not show prognostic superiority for the use of BB (19). These lines of evidence strongly suggest that benefits of BB may be limited in AMI survivors, at least, in those without LVSD or at lower mortality risk.…”

supporting

confidence: 52%

See 1 more Smart Citation

Are beta blockers still necessary for all survivors of acute myocardial infarction?

Nakatani

Sakata

2017

J. Thorac. Dis.

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supporting

confidence: 78%

supporting

confidence: 52%

Are beta blockers still necessary for all survivors of acute myocardial infarction?

Nakatani

Sakata

2017

J. Thorac. Dis.

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“…Even though several investigators have studied the benefits of β‐blocker use among patients with myocardial infarction, our study stressed the impact of β‐blocker therapy, especially relatively low β‐blocker dose, on reducing all‐cause mortality in patients after elective PCI, and provided the evidence to support the idea that the benefit of oral β‐blocker therapy might be confined to patients with NSTEMI 35. Evidence has suggested that the benefit of β‐blockers for patients with NSTEMI may be due to the multivessel disease commonly presenting in them and its sympathetic hyperactivity 36, 37, 38, 39.…”

Section: Discussionmentioning

confidence: 86%

Relationship Between β‐Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Sun

Shen

et al. 2016

JAHA

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BackgroundThe evidence supporting the use of β‐blockers in patients with acute coronary syndrome after successful percutaneous coronary intervention has been inconsistent and scarce.Methods and ResultsBetween March 1, 2009, and December 30, 2014, a total of 3180 eligible patients with acute coronary syndrome undergoing percutaneous coronary intervention were consecutively enrolled. The primary end point was all‐cause death and the secondary end point was a composite of all‐cause death, nonfatal myocardial infarction, heart failure readmission, and cardiogenic hospitalization. Patients were compared according to the use of β‐blockers at discharge. Compared with the no β‐blocker group, the risk of all‐cause death was significantly lower in the β‐blocker group (hazard ratio [HR], 0.33; 95% CI, 0.17–0.65 [P=0.001]). A consistent result was obtained in multiple adjusted model and propensity score–matched analysis. The use of β‐blockers was also associated with decreased risk of composite of adverse cardiovascular events (HR, 0.47; 95% CI, 0.28–0.81 [P=0.006]), although statistical significance disappeared after multivariable adjustment and propensity score matching. Furthermore, we performed post hoc analysis for the subsets of patients and the results revealed that patients with non–ST‐segment elevation myocardial infarction benefited the most from β‐blocker therapy at discharge (HR, 0.04; 95% CI, 0.00–0.27 [P=0.001]), and the use of <50% of target dose was significantly associated with better outcome compared with no β‐blocker use, rather than ≥50% of target dose.ConclusionsThe administration of relatively low β‐blocker dose is associated with improved clinical outcomes among patients with acute coronary syndrome after successful percutaneous coronary intervention, especially for patients with non‐ST‐segment elevation myocardial infarction.

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“…Early intravenous administration of metoprolol therapy in (predominantly) patients with STEMI decreased the risks of reinfarction and ventricular fibrillation, but not mortality, for up to 4 weeks of treatment in the COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction) trial 23. For the long‐term outcome, β‐blocker therapy was associated with improved survival in a subgroup of patients with reduced LV ejection fraction,11 but not in those without heart failure and LV systolic dysfunction 10, 24…”

Section: Discussionmentioning

confidence: 99%

Effect of β‐Blockers Beyond 3 Years After Acute Myocardial Infarction

Park

Kim

Kang

et al. 2018

JAHA

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BackgroundThe 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 ResultsWe 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.ConclusionsThe 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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Meta-Analysis of Relation Between Oral β-Blocker Therapy and Outcomes in Patients With Acute Myocardial Infarction Who Underwent Percutaneous Coronary Intervention

Cited by 70 publications

References 26 publications

Are beta blockers still necessary for all survivors of acute myocardial infarction?

Are beta blockers still necessary for all survivors of acute myocardial infarction?

Relationship Between β‐Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Effect of β‐Blockers Beyond 3 Years After Acute Myocardial Infarction

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