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Circ J. 2019 Jan 25;83(2):410-417. doi: 10.1253/circj.CJ-18-0662. Epub 2018 Nov 22.

Prognostic Impact of β-Blocker Dose After Acute Myocardial Infarction.

Author information

1
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital.
2
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine.
3
Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine.
4
National Maritime Medical Center.
5
Department of Cardiology, Yeungnam University Medical Center.
6
School of Medicine, Kyungpook National University.
7
Cardiology Division, Department of Internal Medicine, Chungbuk National University Hospital.
8
Department of Internal Medicine, Kyunghee University College of Medicine.
9
Department of Internal Medicine and Heart Center, Chonnam National University Hospital.

Abstract

BACKGROUND:

The differential prognostic impact of β-blocker dose after acute myocardial infarction (AMI) has been under debate. The current study sought to compare clinical outcome after AMI according to β-blocker dose using the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH). Methods and Results: Of the total population of 13,104 consecutive AMI patients enrolled in the KAMIR-NIH, the current study analyzed 11,909 patients. These patients were classified into 3 groups (no β-blocker; low-dose [<25% of target dose]; and high-dose [≥25% of target dose]). The primary outcome was cardiac death at 1 year. Compared with the no β-blocker group, both the low-dose and high-dose groups had significantly lower risk of cardiac death (HR, 0.435; 95% CI: 0.363-0.521, P<0.001; HR, 0.519; 95% CI: 0.350-0.772, P=0.001, respectively). The risk of cardiac death, however, was similar between the high- and low-dose groups (HR, 1.194; 95% CI: 0.789-1.808, P=0.402). On multivariable adjustment and inverse probability weighted analysis, the result was the same.

CONCLUSIONS:

The use of β-blockers in post-AMI patients had significant survival benefit compared with no use of β-blockers. There was no significant additional benefit of high-dose β-blockers compared with low-dose β-blockers, however, in terms of 1-year risk of cardiac death.

KEYWORDS:

Acute myocardial infarction; Beta-blocker; Outcome; Prognosis

PMID:
30464110
DOI:
10.1253/circj.CJ-18-0662
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