Association of Beta-Blocker Therapy at Discharge With Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Title
Association of Beta-Blocker Therapy at Discharge With Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Author(s)
박종선양정훈[양정훈]한주영[한주영]송영빈[송영빈]최승혁[최승혁]최진호[최진호]이상훈[이상훈]김주한[김주한]안영근[안영근]정명호[정명호]최동주[최동주]김영조박헌식[박헌식]나승운[나승운]권현철[권현철]
Keywords
OUTPATIENTS; CARVEDILOL; MANAGEMENT; MORTALITY; RISK
Issue Date
201406
Publisher
ELSEVIER SCIENCE INC
Citation
JACC-CARDIOVASCULAR INTERVENTIONS, v.7, no.6, pp.592 - 601
Abstract
Objectives This study sought to investigate the association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Background Limited data are available on the efficacy of beta-blocker therapy for secondary prevention in STEMI patients. Methods Between November 1, 2005 and September 30, 2010, 20,344 patients were enrolled in nationwide, prospective, multicenter registries. Among these, we studied STEMI patients undergoing primary PCI who were discharged alive (n = 8,510). We classified patients into the beta-blocker group (n 6,873) and no-beta-blocker group (n 1,637) according to the use of beta-blockers at discharge. Propensity-score matching analysis was also performed in 1,325 patient triplets. The primary outcome was all-cause death. Results The median follow-up duration was 367 days (interquartile range: 157 to 440 days). All-cause death occurred in 146 patients (2.1%) of the beta-blocker group versus 59 patients (3.6%) of the no-beta-blocker group (p < 0.001). After 2: 1 propensity-score matching, beta-blocker therapy was associated with a lower incidence of all-cause death (2.8% vs. 4.1%, adjusted hazard ratio: 0.46, 95% confidence interval: 0.27 to 0.78, p = 0.004). The association with better outcome of beta-blocker therapy in terms of all-cause death was consistent across various subgroups, including patients with relatively low-risk profiles such as ejection fraction >40% or single-vessel disease. Conclusions Beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI. Our results support the current American College of Cardiology/American Heart Association guidelines, which recommend long-term beta-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile. (C) 2014 by the American College of Cardiology Foundation
URI
http://hdl.handle.net/YU.REPOSITORY/32022http://dx.doi.org/10.1016/j.jcin.2013.12.206
ISSN
1936-8798
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의과대학 > 내과학교실 > Articles
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