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Benefit of Vasodilating ?-Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study.

ABSTRACT: Although current guidelines recommend ?-blocker after acute myocardial infarction (MI), the role of ?-blocker has not been well investigated in the modern reperfusion era. In particular, the benefit of vasodilating ?-blocker over conventional ?-blocker is still unexplored.Using nation-wide multicenter Korean Acute Myocardial Infarction Registry data, we analyzed clinical outcomes of 7127 patients with acute MI who underwent successful percutaneous coronary intervention with stents and took ?-blockers: vasodilating ?-blocker (n=3482), and conventional ?-blocker (n=3645). In the whole population, incidence of cardiac death at 1 year was significantly lower in the vasodilating ?-blocker group (vasodilating ?-blockers versus conventional ?-blockers, 1.0% versus 1.9%; P=0.003). In 2882 pairs of propensity score-matched population, the incidence of cardiac death was significantly lower in the vasodilating ?-blocker group (1.1% versus 1.8%; P=0.028). Although incidences of MI (1.1% versus 1.5%; P=0.277), any revascularization (2.8% versus 3.0%; P=0.791), and hospitalization for heart failure (1.4% versus 1.9%; P=0.210) were not different between the 2 groups, incidences of cardiac death or MI (2.0% versus 3.1%; P=0.010), cardiac death, MI, or hospitalization for heart failure (3.0% versus 4.5%; P=0.003), cardiac death, MI, or any revascularization (3.9% versus 5.3%; P=0.026), and cardiac death, MI, any revascularization, or hospitalization for heart failure (4.8% versus 6.5%; P=0.011) were significantly lower in the vasodilating ?-blocker group.Vasodilating ?-blocker therapy resulted in better clinical outcomes than conventional ?-blocker therapy did in patients with acute MI in the modern reperfusion era. Vasodilating ?-blockers could be recommended preferentially to conventional ones for acute MI patients.

SUBMITTER: Chung J

PROVIDER: S-EPMC5721887 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Benefit of Vasodilating β-Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study.

Chung Jaehoon J Han Jung-Kyu JK Kim Young Jo YJ Kim Chong Jin CJ Ahn Youngkeun Y Chan Cho Myeong M Chae Shung Chull SC Chae In-Ho IH Chae Jei Keon JK Seong In-Whan IW Yang Han-Mo HM Park Kyung-Woo KW Kang Hyun-Jae HJ Koo Bon-Kwon BK Jeong Myung Ho MH Jeong Myung Ho MH Kim Hyo-Soo HS

Journal of the American Heart Association 20171024 10

<h4>Background</h4>Although current guidelines recommend β-blocker after acute myocardial infarction (MI), the role of β-blocker has not been well investigated in the modern reperfusion era. In particular, the benefit of vasodilating β-blocker over conventional β-blocker is still unexplored.<h4>Methods and results</h4>Using nation-wide multicenter Korean Acute Myocardial Infarction Registry data, we analyzed clinical outcomes of 7127 patients with acute MI who underwent successful percutaneous c ...[more]

PMID: 29066446

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Project description:BackgroundPrimary percutaneous coronary intervention (PPCI) has been widely recognized as the preferred treatment for ST-segment-elevation myocardial infarction (STEMI). However, substantial numbers of STEMI patients cannot receive timely PPCI. Early fibrinolysis followed by routine percutaneous coronary intervention (FPCI) has been proposed as an effective and safe alternative for eligible patients. To date, few studies have compared FPCI with PPCI in terms of microvascular reperfusion. This study aimed to evaluate the microvascular function of FPCI and PPCI.MethodsSTEMI patients at the Peking University First Hospital and Miyun Hospital were enrolled in this retrospective study between January 2015 to December 2020. Microvascular function documented by the coronary angiography-derived index of microvascular resistance (caIMR) was measured at the final angiogram after revascularization. The primary end point was the caIMR of the culprit vessels. The secondary end points were in-hospital and follow-up major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal recurrent myocardial infarction, target-vessel revascularization (TVR), and non-fatal stroke/transient ischemic attacks (TIA). Details of the adverse clinical events were obtained from telephone interviews and electronic medical record systems until January 2022.ResultsIn total, 496 STEMI patients were enrolled in this cross-sectional retrospective study. Of these patients, 81 underwent FPCI, and 415 underwent PPCI. At the baseline, the PPCI patients had a higher-risk profile than the FPCI patients. The time from symptom onset to reperfusion therapy was significantly shorter in the FPCI group than the PPCI group (median 3.0 vs. 4.5 hours; P<0.001). The caIMR was significantly lower in the FPCI group than the PPCI group (median 20.34 vs. 40.33; P<0.001). The median follow-up duration was 4.1 years. During the follow-up period, the rate of MACE was lower in the FPCI group than the PPCI group [7 (10.1%) vs. 82 (20.8%), P=0.048]. After propensity score matching to adjust for the imbalances at the baseline, the caIMR remained significant and the clinical outcomes did not differ significantly between the two groups.ConclusionsIn eligible STEMI patients, clinically successful FPCI may be associated with better microvascular reperfusion and comparable clinical outcomes as compared with PPCI.

Dataset Information

Benefit of Vasodilating ?-Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study.

Publications

Benefit of Vasodilating β-Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study.

Similar Datasets

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