PMID- 27650822
OWN - NLM
STAT- MEDLINE
DCOM- 20170323
LR  - 20171016
IS  - 1756-1833 (Electronic)
IS  - 0959-8138 (Linking)
VI  - 354
DP  - 2016 Sep 20
TI  - beta blockers and mortality after myocardial infarction in patients without heart
      failure: multicentre prospective cohort study.
PG  - i4801
LID - 10.1136/bmj.i4801 [doi]
AB  - OBJECTIVE: To assess the association between early and prolonged beta blocker
      treatment and mortality after acute myocardial infarction. DESIGN: Multicentre
      prospective cohort study. SETTING: Nationwide French registry of Acute ST- and
      non-ST-elevation Myocardial Infarction (FAST-MI) (at 223 centres) at the end of
      2005. PARTICIPANTS: 2679 consecutive patients with acute myocardial infarction
      and without heart failure or left ventricular dysfunction. MAIN OUTCOME MEASURES:
      Mortality was assessed at 30 days in relation to early use of beta blockers
      (</=48 hours of admission), at one year in relation to discharge prescription,
      and at five years in relation to one year use. RESULTS: beta blockers were used
      early in 77% (2050/2679) of patients, were prescribed at discharge in 80%
      (1783/2217), and were still being used in 89% (1230/1383) of those alive at one
      year. Thirty day mortality was lower in patients taking early beta blockers
      (adjusted hazard ratio 0.46, 95% confidence interval 0.26 to 0.82), whereas the
      hazard ratio for one year mortality associated with beta blockers at discharge
      was 0.77 (0.46 to 1.30). Persistence of beta blockers at one year was not
      associated with lower five year mortality (hazard ratio 1.19, 0.65 to 2.18). In
      contrast, five year mortality was lower in patients continuing statins at one
      year (hazard ratio 0.42, 0.25 to 0.72) compared with those discontinuing statins.
      Propensity score and sensitivity analyses showed consistent results. CONCLUSIONS:
      Early beta blocker use was associated with reduced 30 day mortality in patients
      with acute myocardial infarction, and discontinuation of beta blockers at one
      year was not associated with higher five year mortality. These findings question 
      the utility of prolonged beta blocker treatment after acute myocardial infarction
      in patients without heart failure or left ventricular dysfunction.Trial
      registration Clinical trials NCT00673036.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Puymirat, Etienne
AU  - Puymirat E
AD  - Department of Cardiology, Hopital Europeen Georges Pompidou, 75015 Paris, France 
      Assistance Publique-Hopitaux de Paris, Paris, France Universite Paris-Descartes, 
      Paris, France etienne.puymirat@egp.aphp.fr.
FAU - Riant, Elisabeth
AU  - Riant E
AD  - Department of Cardiology, Hopital Europeen Georges Pompidou, 75015 Paris, France 
      Assistance Publique-Hopitaux de Paris, Paris, France Universite Paris-Descartes, 
      Paris, France.
FAU - Aissaoui, Nadia
AU  - Aissaoui N
AD  - Assistance Publique-Hopitaux de Paris, Paris, France Universite Paris-Descartes, 
      Paris, France Department of Critical Care, Hopital Europeen Georges Pompidou,
      Paris, France.
FAU - Soria, Angele
AU  - Soria A
AD  - Assistance Publique-Hopitaux de Paris, Paris, France Department of Dermatology
      and Allergology, Tenon Hospital, Paris, France Sorbonne University, Universite
      Pierre et Marie Curie (UPMC-Paris 06), Paris, France INSERM U1135-CIMI, Paris,
      France.
FAU - Ducrocq, Gregory
AU  - Ducrocq G
AD  - Assistance Publique-Hopitaux de Paris, Paris, France Hopital Bichat, Paris,
      France Universite Paris Diderot, Paris, France INSERM U 698, Paris, France.
FAU - Coste, Pierre
AU  - Coste P
AD  - Hopital cardiologique du Haut Leveque, Pessac, France Universite Bordeaux
      Segalen, Bordeaux, France.
FAU - Cottin, Yves
AU  - Cottin Y
AD  - Hopital du Bocage, Dijon, France Universite de Bourgogne, Dijon, France.
FAU - Aupetit, Jean Francois
AU  - Aupetit JF
AD  - Hopital St Joseph et St Luc, Lyon, France.
FAU - Bonnefoy, Eric
AU  - Bonnefoy E
AD  - Hopital cardiologique Louis Pradel, Lyon, France Universite Lyon 1, Lyon, France.
FAU - Blanchard, Didier
AU  - Blanchard D
AD  - Clinique St Gatien, Tours, France.
FAU - Cattan, Simon
AU  - Cattan S
AD  - Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
FAU - Steg, Gabriel
AU  - Steg G
AD  - Assistance Publique-Hopitaux de Paris, Paris, France Hopital Bichat, Paris,
      France Universite Paris Diderot, Paris, France INSERM U 698, Paris, France.
FAU - Schiele, Francois
AU  - Schiele F
AD  - Hopital Jean Minjoz, Besancon, France Universite de Franche Comte, Besancon,
      France.
FAU - Ferrieres, Jean
AU  - Ferrieres J
AD  - Department of Cardiology B and Epidemiology, Toulouse University Hospital,
      Toulouse, France UMR INSERM 1027, Toulouse, France.
FAU - Juilliere, Yves
AU  - Juilliere Y
AD  - Institut Lorrain du Coeur et des Vaisseaux Universite de Lorraine, Nancy, France.
FAU - Simon, Tabassome
AU  - Simon T
AD  - Assistance Publique-Hopitaux de Paris, Paris, France Hopital Saint Antoine,
      Department of Clinical Pharmacology and Unite de Recherche Clinique (URCEST),
      Paris, France.
FAU - Danchin, Nicolas
AU  - Danchin N
AD  - Department of Cardiology, Hopital Europeen Georges Pompidou, 75015 Paris, France 
      Assistance Publique-Hopitaux de Paris, Paris, France Universite Paris-Descartes, 
      Paris, France.
LA  - eng
SI  - ClinicalTrials.gov/NCT00673036
PT  - Journal Article
PT  - Multicenter Study
DEP - 20160920
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
RN  - 0 (Adrenergic beta-Antagonists)
SB  - AIM
SB  - IM
MH  - Acute Disease
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Aged
MH  - Coronary Care Units
MH  - Female
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy/*mortality
MH  - Patient Discharge/statistics & numerical data
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Survival Analysis
MH  - Time Factors
PMC - PMC5029148
COIS- All authors have completed the ICMJE uniform disclosure form at
      www.icmje.org/coi_disclosure.pdf (available on request from the corresponding
      author) and declare: EP has received speaker, board membership, and consulting
      fees from Amgen, AstraZeneca, Bayer, Daiichi Sankyo, Lilly, MSD, and
      Sanofi-Aventis; SC has received grants from AstraZeneca, Boehringer Ingelheim,
      Boston Scientific, Medtronic, and Servier; GS has received institutional research
      grant support from NYU School of Medicine, Sanofi-Aventis, and Servier and
      consulting/advisory board fees from Ablynx, Amarin, Astellas, AstraZeneca, Bayer,
      Boehringer-Ingelheim, BMS, Daiichi-Sankyo-Lilly, GSK, Medtronic, MSD, Novartis,
      Otsuka, Pfizer, Roche, Sanofi-Aventis, Servier, and The Medicines Company and is 
      a stockholder and co-founder of Aterovax; FS has received grant support to his
      institution and travel support for scientific meetings from AstraZeneca,
      Boehringer-Ingelheim, Daiichi-Sankyo, Lilly, Medtronic, Pfizer; Sanofi-Aventis,
      Servier, and Takeda; JF has received grants and speaker fees from AstraZeneca,
      Genzyme, Merck, Novartis, and Servier. TS has received research grants from
      Astra-Zeneca, Daiichi-Sankyo, Eli-Lilly, Glaxo-Smith-Kline, MSD, Novartis,
      Pfizer, Sanofi-Aventis, and Servier and speaker and consulting fees from
      AstraZeneca, Bayer-Schering, Eli-Lilly, and Sanofi-Aventis; ND has received
      research grants from AstraZeneca, Daiichi-Sankyo, Eli-Lilly, Glaxo-Smith-Kline,
      MSD, Novartis, Pfizer, Sanofi-Aventis, Servier, and The Medicines Company and
      advisory panel or lecture fees from AstraZeneca, Boehringer-Ingelheim,
      Bristol-Myers Squibb, Eli-Lilly, Menarini, Merck-Serono, Novo-Nordisk, Servier,
      and Sanofi-Aventis; no other relationships or activities that could appear to
      have influenced the submitted work.
EDAT- 2016/09/22 06:00
MHDA- 2017/03/24 06:00
CRDT- 2016/09/22 06:00
PHST- 2016/09/22 06:00 [entrez]
PHST- 2016/09/22 06:00 [pubmed]
PHST- 2017/03/24 06:00 [medline]
PST - epublish
SO  - BMJ. 2016 Sep 20;354:i4801.