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J Am Coll Cardiol. 2017 Jun 6;69(22):2710-2720. doi: 10.1016/j.jacc.2017.03.578.

β-Blockers and Mortality After Acute Myocardial Infarction in Patients Without Heart Failure or Ventricular Dysfunction.

Author information

1
Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
2
Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
3
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
4
Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
5
Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
6
Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France; Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris-Descartes, Paris, France.
7
National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom.
8
University College London, London, and Farr Institute of Health Informatics Research, London, United Kingdom.
9
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
10
The National Institute for Health Biomedical Research Unit, Bart's Heart Centre, London, United Kingdom.
11
Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom; Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, United Kingdom. Electronic address: c.p.gale@leeds.ac.uk.

Abstract

BACKGROUND:

For acute myocardial infarction (AMI) without heart failure (HF), it is unclear if β-blockers are associated with reduced mortality.

OBJECTIVES:

The goal of this study was to determine the association between β-blocker use and mortality in patients with AMI without HF or left ventricular systolic dysfunction (LVSD).

METHODS:

This cohort study used national English and Welsh registry data from the Myocardial Ischaemia National Audit Project. A total of 179,810 survivors of hospitalization with AMI without HF or LVSD, between January 1, 2007, and June 30, 2013 (final follow-up: December 31, 2013), were assessed. Survival-time inverse probability weighting propensity scores and instrumental variable analyses were used to investigate the association between the use of β-blockers and 1-year mortality.

RESULTS:

Of 91,895 patients with ST-segment elevation myocardial infarction and 87,915 patients with non-ST-segment elevation myocardial infarction, 88,542 (96.4%) and 81,933 (93.2%) received β-blockers, respectively. For the entire cohort, with >163,772 person-years of observation, there were 9,373 deaths (5.2%). Unadjusted 1-year mortality was lower for patients who received β-blockers compared with those who did not (4.9% vs. 11.2%; p < 0.001). However, after weighting and adjustment, there was no significant difference in mortality between those with and without β-blocker use (average treatment effect [ATE] coefficient: 0.07; 95% confidence interval [CI]: -0.60 to 0.75; p = 0.827). Findings were similar for ST-segment elevation myocardial infarction (ATE coefficient: 0.30; 95% CI: -0.98 to 1.58; p = 0.637) and non-ST-segment elevation myocardial infarction (ATE coefficient: -0.07; 95% CI: -0.68 to 0.54; p = 0.819).

CONCLUSIONS:

Among survivors of hospitalization with AMI who did not have HF or LVSD as recorded in the hospital, the use of β-blockers was not associated with a lower risk of death at any time point up to 1 year. (β-Blocker Use and Mortality in Hospital Survivors of Acute Myocardial Infarction Without Heart Failure; NCT02786654).

KEYWORDS:

NSTEMI; STEMI; average treatment effect; preserved left ventricular systolic function; propensity score; survival

PMID:
28571635
PMCID:
PMC5457288
DOI:
10.1016/j.jacc.2017.03.578
[Indexed for MEDLINE]
Free PMC Article

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