Dataset Information

Relationship Between ?-Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

ABSTRACT: The evidence supporting the use of ?-blockers in patients with acute coronary syndrome after successful percutaneous coronary intervention has been inconsistent and scarce.Between March 1, 2009, and December 30, 2014, a total of 3180 eligible patients with acute coronary syndrome undergoing percutaneous coronary intervention were consecutively enrolled. The primary end point was all-cause death and the secondary end point was a composite of all-cause death, nonfatal myocardial infarction, heart failure readmission, and cardiogenic hospitalization. Patients were compared according to the use of ?-blockers at discharge. Compared with the no ?-blocker group, the risk of all-cause death was significantly lower in the ?-blocker group (hazard ratio [HR], 0.33; 95% CI, 0.17-0.65 [P=0.001]). A consistent result was obtained in multiple adjusted model and propensity score-matched analysis. The use of ?-blockers was also associated with decreased risk of composite of adverse cardiovascular events (HR, 0.47; 95% CI, 0.28-0.81 [P=0.006]), although statistical significance disappeared after multivariable adjustment and propensity score matching. Furthermore, we performed post hoc analysis for the subsets of patients and the results revealed that patients with non-ST-segment elevation myocardial infarction benefited the most from ?-blocker therapy at discharge (HR, 0.04; 95% CI, 0.00-0.27 [P=0.001]), and the use of <50% of target dose was significantly associated with better outcome compared with no ?-blocker use, rather than ?50% of target dose.The administration of relatively low ?-blocker dose is associated with improved clinical outcomes among patients with acute coronary syndrome after successful percutaneous coronary intervention, especially for patients with non-ST-segment elevation myocardial infarction.

SUBMITTER: Li C

PROVIDER: S-EPMC5210364 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Relationship Between β-Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Li Chenze C Sun Yang Y Shen Xiaoqing X Yu Ting T Li Qing Q Ruan Guoran G Zhang Lina L Huang Qiang Q Zhuang Hang H Huang Jingqiu J Ni Li L Wang Luyun L Jiang Jiangang J Wang Yan Y Wang Dao Wen DW

Journal of the American Heart Association 20161116 11

<h4>Background</h4>The evidence supporting the use of β-blockers in patients with acute coronary syndrome after successful percutaneous coronary intervention has been inconsistent and scarce.<h4>Methods and results</h4>Between March 1, 2009, and December 30, 2014, a total of 3180 eligible patients with acute coronary syndrome undergoing percutaneous coronary intervention were consecutively enrolled. The primary end point was all-cause death and the secondary end point was a composite of all-caus ...[more]

PMID: 27852588

Similar Datasets

Project description:BackgroundResidual risk remained significant despite effective low density lipoprotein cholesterol (LDL-C) lowering treatment. Small dense low density lipoprotein cholesterol (sdLDL-C) as part of LDL-C has been found to be predictor of coronary heart disease (CHD) and cardiovascular (CV) events in patients with stable CHD independently of LDL-C. However, to date, few studies have explored the role of sdLDL-C in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Accordingly, this study aimed to evaluate the association of sdLDL-C with CV events in patients with ACS undergoing PCI.MethodsPatients hospitalized with ACS undergoing PCI were enrolled and followed up for 18 months. The risk of sdLDL-C for CV events was compared according to sdLDL-C quartiles. The primary outcome was major cardiovascular and cerebrovascular adverse events (MACCE), which was the composite of all cause of death, nonfatal myocardial infarction (MI), nonfatal stroke or unplanned repeat revascularization. A Cox proportional hazards regression model was performed to estimate the risk of CV events. Subgroup analysis according to diabetes status and LDL-C were performed separately for MACCE.ResultsA total of 6092 patients were included in the analysis (age: 60.2 ± 10.13 years, male: 75.3%, BMI: 25.9 ± 3.33 kg/m2, dyslipidemia: 74.1% and diabetes: 44.5%). During 18 months of follow-up, 320 (5.2%) incident CV events occurred. Compared to the lowest sdLDL-C quartile group, patients in the highest quartile had a greater risk of CV events after multivariable adjustment (HR 1.92; 95% CI 1.37-2.70). In addition, it was mainly due to the increase of unplanned repeat revascularization. In the subgroup analyses, significant association was observed regardless of level of LDL-C and diabetes status.ConclusionsPatients with elevated sdLDL-C have a higher risk of CV events in Chinese patients with ACS undergoing PCI, providing additional value for better risk assessment.

Project description:Objective:We aim to evaluate the long-term prognosis of non-ST elevation acute coronary syndrome (NSTE-ACS) patients with high-risk coronary anatomy (HRCA). Background:Coronary disease severity is important for therapeutic decision-making and prognostication among patients presenting with NSTE-ACS. However, long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with HRCA is still unknown. Method:NSTE-ACS patients undergoing PCI in Fuwai Hospital in 2013 were prospectively enrolled and subsequently divided into HRCA and low-risk coronary anatomy (LRCA) groups according to whether angiography complies with the HRCA definition. HRCA was defined as left main disease >50%, proximal LAD lesion >70%, or 2- to 3- vessel disease involving the LAD. Prognosis impact on 2-year and 5-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed. Results:Out of 4,984 enrolled patients with NSTE-ACS, 3,752 patients belonged to the HRCA group, while 1,232 patients belonged to the LRCA group. Compared with the LRCA group, patients in the HRCA group had worse baseline characteristics including higher age, more comorbidities, and worse angiographic findings. Patients in the HRCA group had higher incidence of unplanned revascularization (2 years: 9.7% vs. 5.1%, p < 0.001; 5 years: 15.4% vs. 10.3%, p < 0.001), 2-year MACCE (13.1% vs. 8.8%, p < 0.001), and 5-year death/MI/revascularization/stroke (23.0% vs. 18.4%, p = 0.001). Kaplan-Meier survival analysis showed similar results. After adjusting for confounding factors, HRCA is independently associated with higher risk of revascularization (2 years: HR?=?1.636, 95% CI: 1.225-2.186; 5 years: HR?=?1.460, 95% CI: 1.186-1.798), 2-year MACCE (HR?=?1.275, 95% CI?=?1.019-1.596) and 5-year death/MI/revascularization/stroke (HR?=?1.183, 95% CI: 1.010-1.385). Conclusion:In our large cohort of Chinese patients, HRCA is an independent risk factor for long-term unplanned revascularization and MACCE.

Dataset Information

Relationship Between ?-Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Publications

Relationship Between β-Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets