Association Between Early Oral β-Blocker Therapy and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction With Mild-Moderate Heart Failure: Findings From the CCC-ACS Project

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2022 May 2

PMID 35497978

Authors

Miao Wang

Jing Liu

Jun Liu

Yongchen Hao

Na Yang

Tong Liu

Sidney C Smith Jr

Yong Huo

Gregg C Fonarow

Junbo Ge

Louise Morgan

Changsheng Ma

Yaling Han

Dong Zhao

Siyan Zhan

Affiliations

Soon will be listed here.

Abstract

Background: There are limited data available on the impact of early (within 24 h of admission) β-blocker therapy on in-hospital outcomes of patients with ST-elevation myocardial infarction (STEMI) and mild-moderate acute heart failure. This study aimed to explore the association between early oral β-blocker therapy and in-hospital outcomes.

Methods: Inpatients with STEMI and Killip class II or III heart failure from the Improving Care for Cardiovascular Disease in China project ( = 10,239) were enrolled. The primary outcome was a combined endpoint composed of in-hospital all-cause mortality, successful cardiopulmonary resuscitation after cardiac arrest, and cardiogenic shock. Inverse-probability-of-treatment weighting, multivariate Cox regression, and propensity score matching were performed.

Results: Early oral β-blocker therapy was administered to 56.5% of patients. The incidence of the combined endpoint events was significantly lower in patients with early therapy than in those without (2.7 vs. 5.1%, < 0.001). Inverse-probability-of-treatment weighting analysis demonstrated that early β-blocker therapy was associated with a low risk of combined endpoint events (HR = 0.641, 95% CI: 0.486-0.844, = 0.002). Similar results were shown in multivariate Cox regression (HR = 0.665, 95% CI: 0.496-0.894, = 0.007) and propensity score matching (HR = 0.633, 95% CI: 0.453-0.884, = 0.007) analyses. A dose-response trend between the first-day β-blocker dosages and adverse outcomes was observed in a subset of participants with available data. No factor could modify the association of early treatment and the primary outcomes among the subgroups analyses.

Conclusion: Based on nationwide Chinese data, early oral β-blocker therapy is independently associated with a lower risk of poor in-hospital outcome in patients with STEMI and Killip class II or III heart failure.

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References

Poole-Wilson P, Swedberg K, Cleland J, Lenarda A, Hanrath P, Komajda M . Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet. 2003; 362(9377):7-13. DOI: 10.1016/S0140-6736(03)13800-7. View

Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European.... Eur Heart J. 2017; 39(2):119-177. DOI: 10.1093/eurheartj/ehx393. View

Hao Y, Liu J, Liu J, Smith Jr S, Huo Y, Fonarow G . Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome. Am Heart J. 2016; 179:107-15. DOI: 10.1016/j.ahj.2016.06.005. View

Wikstrand J, Wedel H, Castagno D, McMurray J . The large-scale placebo-controlled beta-blocker studies in systolic heart failure revisited: results from CIBIS-II, COPERNICUS and SENIORS-SHF compared with stratified subsets from MERIT-HF. J Intern Med. 2013; 275(2):134-43. DOI: 10.1111/joim.12141. View

Flather M, Shibata M, Coats A, Van Veldhuisen D, Parkhomenko A, Borbola J . Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J. 2005; 26(3):215-25. DOI: 10.1093/eurheartj/ehi115. View

. [Chinese guidelines for the diagnosis and treatment of heart failure 2018]. Zhonghua Xin Xue Guan Bing Za Zhi. 2018; 46(10):760-789. DOI: 10.3760/cma.j.issn.0253-3758.2018.10.004. View

Tamaki Y, Yaku H, Morimoto T, Inuzuka Y, Ozasa N, Yamamoto E . Lower In-Hospital Mortality With Beta-Blocker Use at Admission in Patients With Acute Decompensated Heart Failure. J Am Heart Assoc. 2021; 10(13):e020012. PMC: 8403288. DOI: 10.1161/JAHA.120.020012. View

Baechli C, Koch D, Bernet S, Gut L, Wagner U, Mueller B . Association of comorbidities with clinical outcomes in patients after acute myocardial infarction. Int J Cardiol Heart Vasc. 2020; 29:100558. PMC: 7298557. DOI: 10.1016/j.ijcha.2020.100558. View

Pfisterer M, Cox J, Granger C, Brener S, Naylor C, Califf R . Atenolol use and clinical outcomes after thrombolysis for acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries. J Am Coll Cardiol. 1998; 32(3):634-40. DOI: 10.1016/s0735-1097(98)00279-4. View

10.

Chen Z, Pan H, Chen Y, Peto R, Collins R, Jiang L . Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005; 366(9497):1622-32. DOI: 10.1016/S0140-6736(05)67661-1. View

11.

Dharma S, Dakota I, Andriantoro H, Firdaus I, Rahma S, Siswanto B . Association of gender with clinical outcomes of patients with acute ST-segment elevation myocardial infarction presenting with acute heart failure. Coron Artery Dis. 2020; 32(1):17-24. DOI: 10.1097/MCA.0000000000000892. View

12.

Roberts R, Rogers W, Mueller H, LAMBREW C, Diver D, Smith H . Immediate versus deferred beta-blockade following thrombolytic therapy in patients with acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) II-B Study. Circulation. 1991; 83(2):422-37. DOI: 10.1161/01.cir.83.2.422. View

13.

Packer M, Bristow M, Cohn J, Colucci W, Fowler M, Gilbert E . The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med. 1996; 334(21):1349-55. DOI: 10.1056/NEJM199605233342101. View

14.

OGara P, Kushner F, Ascheim D, Casey Jr D, Chung M, de Lemos J . 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2012; 61(4):e78-e140. DOI: 10.1016/j.jacc.2012.11.019. View

15.

Kyriakidis M, Trikas A, Triposkiadis F, Kofinas G, Tsakiris M, Antonopoulos A . Sinus node dysfunction in acute inferior myocardial infarction. Role of sinus node artery and clinical course in patients with one-vessel coronary artery disease. Cardiology. 1997; 88(2):166-9. DOI: 10.1159/000177325. View

16.

Thomas L, Li F . Addressing Extreme Propensity Scores via the Overlap Weights. Am J Epidemiol. 2018; 188(1):250-257. DOI: 10.1093/aje/kwy201. View

17.

Packer M, Coats A, Fowler M, Katus H, Krum H, Mohacsi P . Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001; 344(22):1651-8. DOI: 10.1056/NEJM200105313442201. View

18.

. [Guideline for diagnosis and treatment of patients with ST-elevation myocardial infarction]. Zhonghua Xin Xue Guan Bing Za Zhi. 2010; 38(8):675-90. View

19.

McDonagh T, Metra M, Adamo M, Gardner R, Baumbach A, Bohm M . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36):3599-3726. DOI: 10.1093/eurheartj/ehab368. View

20.

Liu S, Li Y, Zeng X, Wang H, Yin P, Wang L . Burden of Cardiovascular Diseases in China, 1990-2016: Findings From the 2016 Global Burden of Disease Study. JAMA Cardiol. 2019; 4(4):342-352. PMC: 6484795. DOI: 10.1001/jamacardio.2019.0295. View