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ȣ - 540813 308 |
| Pattern of use and efficacy of beta-blocker therapy in patients with acute heart failure after acute myocardial infarction from the Korea Acute Myocardial Infarction Registry |
| 경북대학교병원 순환기 내과¹ , 영남대학교 순환기 내과²,전남대학교 순환기 내과³ , 대구가톨릭대학교 순환기 내과⁴ , 계명대학교 순환기 내과5 , 충남대학교 순환기 내과6 , 부산대학교 순환기 내과7 , 충북대학교 순환기 내과8 ,경희대학교 동서 신의학 병원9 |
| 이장훈¹, 채성철¹ , 박선희¹ , 강정규¹ , 김나영¹ , 양동헌¹ , 박헌식¹ , 조용근¹ , 전재은¹ , 박의현 ¹ , 김영조² , 정명호³ , 김기식⁴ ,허승호5 ,성인환6 , 홍택종7 , 조명찬8 , 김종진9 |
Background: Beta-blockers (BBs) have been shown to improve major adverse cardiac events (MACE) in previous studies of patients with symptomatic chronic heart failure (HF). However, patterns of use and efficacy of BBs in acute HF after acute myocardial infarction (AMI) remains unclear. Methods: Between November 2005 and January 2008, 1,682 patients (1,037 men; mean age = 67.2 ± 11.8 years-old) with acute HF of Killip class II-III, without contraindications to BBs, were selected from the Korea AMI registry. The 12-month MACE was defined as a composite of death, non-fatal MI, and revascularizations. Results: The BBs were used in 66.9% of patients with AMI (67.4% with Killip class II versus 66.1% with class III; p=0.588). Patients receiving BBs were younger with more dyspnea at presentaion, less inferior MI, higher body mass index, higher systolic and diastolic blood pressure, and higher total cholesterol levels. Cardiogenic shock and ventricular arrhythmia during hospitalization were less frequently observed in BBs patients. Percutaneous coronary intervention was more frequently performed in patients receiving BBs. In Cox proportional-hazards model, the 12-month MACE (21.9% versus 29.3%; crude hazard ratio [HR] 0.674, 95% confidence interval [CI] 0.553–0.822; p<0.001) and mortality (15.4% versus 24.20%; crude HR 0.578, 95% CI 0.462–0.724; p<0.001) were significantly lower in BBs patients compared with no-BBs patients. Propensity scores (PS) for BBs use was calculated for each of the patients, and was used to match 453 patients not receiving BBs with 453 patients receiving BBs. During the follow-up, 232 (25.6%) MACEs and 181 (20.0%) deaths from any cause occurred in the matched cohort. In Cox proportional-hazards model, there were no significant differences in the rate of 12-month MACE (25.4% versus 25.8%; HR 0.950, 95%CI 0.735–1.229; p=0.699) and mortality (19.4% versus 20.5%; HR 0.915, 95%CI 0.683–1.224; p=0.548) between BBs and no-BBs patients. Conclusions: Many high-risk post-MI patients with acute HF do not receive BB therapy. Although the benefit of BBs was substantial before PS match, these benefits could not be maintained after PS match in acute HF after AMI. Further studies are required in these patients.
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