Association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Jeong Hoon Yang, Joo Yong Hahn, Young Bin Song, Seung Hyuk Choi, Jin Ho Choi, Sang Hoon Lee, Joo Han Kim, Young Keun Ahn, Myung Ho Jeong, Dong Joo Choi, Jong Seon Park, Young Jo Kim, Hun Sik Park, Kyoo Rok Han, Seung-Woon Rha, Hyeon Cheol Gwon

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objectives This study sought to investigate the association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Background Limited data are available on the efficacy of beta-blocker therapy for secondary prevention in STEMI patients. Methods Between November 1, 2005 and September 30, 2010, 20,344 patients were enrolled in nationwide, prospective, multicenter registries. Among these, we studied STEMI patients undergoing primary PCI who were discharged alive (n = 8,510). We classified patients into the beta-blocker group (n = 6,873) and no-beta-blocker group (n = 1,637) according to the use of beta-blockers at discharge. Propensity-score matching analysis was also performed in 1,325 patient triplets. The primary outcome was all-cause death. Results The median follow-up duration was 367 days (interquartile range: 157 to 440 days). All-cause death occurred in 146 patients (2.1%) of the beta-blocker group versus 59 patients (3.6%) of the no-beta-blocker group (p < 0.001). After 2:1 propensity-score matching, beta-blocker therapy was associated with a lower incidence of all-cause death (2.8% vs. 4.1%, adjusted hazard ratio: 0.46, 95% confidence interval: 0.27 to 0.78, p = 0.004). The association with better outcome of beta-blocker therapy in terms of all-cause death was consistent across various subgroups, including patients with relatively low-risk profiles such as ejection fraction >40% or single-vessel disease. Conclusions Beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI. Our results support the current American College of Cardiology/American Heart Association guidelines, which recommend long-term beta-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile.

Original languageEnglish
Pages (from-to)592-601
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume7
Issue number6
DOIs
Publication statusPublished - 2014 Jan 1

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Percutaneous Coronary Intervention
Therapeutics
Cause of Death
ST Elevation Myocardial Infarction
Propensity Score
Secondary Prevention
Reperfusion
Registries
Guidelines
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. / Yang, Jeong Hoon; Hahn, Joo Yong; Song, Young Bin; Choi, Seung Hyuk; Choi, Jin Ho; Lee, Sang Hoon; Kim, Joo Han; Ahn, Young Keun; Jeong, Myung Ho; Choi, Dong Joo; Park, Jong Seon; Kim, Young Jo; Park, Hun Sik; Han, Kyoo Rok; Rha, Seung-Woon; Gwon, Hyeon Cheol.

In: JACC: Cardiovascular Interventions, Vol. 7, No. 6, 01.01.2014, p. 592-601.

Research output: Contribution to journalArticle

Yang, JH, Hahn, JY, Song, YB, Choi, SH, Choi, JH, Lee, SH, Kim, JH, Ahn, YK, Jeong, MH, Choi, DJ, Park, JS, Kim, YJ, Park, HS, Han, KR, Rha, S-W & Gwon, HC 2014, 'Association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention', JACC: Cardiovascular Interventions, vol. 7, no. 6, pp. 592-601. https://doi.org/10.1016/j.jcin.2013.12.206
Yang, Jeong Hoon ; Hahn, Joo Yong ; Song, Young Bin ; Choi, Seung Hyuk ; Choi, Jin Ho ; Lee, Sang Hoon ; Kim, Joo Han ; Ahn, Young Keun ; Jeong, Myung Ho ; Choi, Dong Joo ; Park, Jong Seon ; Kim, Young Jo ; Park, Hun Sik ; Han, Kyoo Rok ; Rha, Seung-Woon ; Gwon, Hyeon Cheol. / Association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. In: JACC: Cardiovascular Interventions. 2014 ; Vol. 7, No. 6. pp. 592-601.
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abstract = "Objectives This study sought to investigate the association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Background Limited data are available on the efficacy of beta-blocker therapy for secondary prevention in STEMI patients. Methods Between November 1, 2005 and September 30, 2010, 20,344 patients were enrolled in nationwide, prospective, multicenter registries. Among these, we studied STEMI patients undergoing primary PCI who were discharged alive (n = 8,510). We classified patients into the beta-blocker group (n = 6,873) and no-beta-blocker group (n = 1,637) according to the use of beta-blockers at discharge. Propensity-score matching analysis was also performed in 1,325 patient triplets. The primary outcome was all-cause death. Results The median follow-up duration was 367 days (interquartile range: 157 to 440 days). All-cause death occurred in 146 patients (2.1{\%}) of the beta-blocker group versus 59 patients (3.6{\%}) of the no-beta-blocker group (p < 0.001). After 2:1 propensity-score matching, beta-blocker therapy was associated with a lower incidence of all-cause death (2.8{\%} vs. 4.1{\%}, adjusted hazard ratio: 0.46, 95{\%} confidence interval: 0.27 to 0.78, p = 0.004). The association with better outcome of beta-blocker therapy in terms of all-cause death was consistent across various subgroups, including patients with relatively low-risk profiles such as ejection fraction >40{\%} or single-vessel disease. Conclusions Beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI. Our results support the current American College of Cardiology/American Heart Association guidelines, which recommend long-term beta-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile.",
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AU - Yang, Jeong Hoon

AU - Hahn, Joo Yong

AU - Song, Young Bin

AU - Choi, Seung Hyuk

AU - Choi, Jin Ho

AU - Lee, Sang Hoon

AU - Kim, Joo Han

AU - Ahn, Young Keun

AU - Jeong, Myung Ho

AU - Choi, Dong Joo

AU - Park, Jong Seon

AU - Kim, Young Jo

AU - Park, Hun Sik

AU - Han, Kyoo Rok

AU - Rha, Seung-Woon

AU - Gwon, Hyeon Cheol

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N2 - Objectives This study sought to investigate the association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Background Limited data are available on the efficacy of beta-blocker therapy for secondary prevention in STEMI patients. Methods Between November 1, 2005 and September 30, 2010, 20,344 patients were enrolled in nationwide, prospective, multicenter registries. Among these, we studied STEMI patients undergoing primary PCI who were discharged alive (n = 8,510). We classified patients into the beta-blocker group (n = 6,873) and no-beta-blocker group (n = 1,637) according to the use of beta-blockers at discharge. Propensity-score matching analysis was also performed in 1,325 patient triplets. The primary outcome was all-cause death. Results The median follow-up duration was 367 days (interquartile range: 157 to 440 days). All-cause death occurred in 146 patients (2.1%) of the beta-blocker group versus 59 patients (3.6%) of the no-beta-blocker group (p < 0.001). After 2:1 propensity-score matching, beta-blocker therapy was associated with a lower incidence of all-cause death (2.8% vs. 4.1%, adjusted hazard ratio: 0.46, 95% confidence interval: 0.27 to 0.78, p = 0.004). The association with better outcome of beta-blocker therapy in terms of all-cause death was consistent across various subgroups, including patients with relatively low-risk profiles such as ejection fraction >40% or single-vessel disease. Conclusions Beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI. Our results support the current American College of Cardiology/American Heart Association guidelines, which recommend long-term beta-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile.

AB - Objectives This study sought to investigate the association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Background Limited data are available on the efficacy of beta-blocker therapy for secondary prevention in STEMI patients. Methods Between November 1, 2005 and September 30, 2010, 20,344 patients were enrolled in nationwide, prospective, multicenter registries. Among these, we studied STEMI patients undergoing primary PCI who were discharged alive (n = 8,510). We classified patients into the beta-blocker group (n = 6,873) and no-beta-blocker group (n = 1,637) according to the use of beta-blockers at discharge. Propensity-score matching analysis was also performed in 1,325 patient triplets. The primary outcome was all-cause death. Results The median follow-up duration was 367 days (interquartile range: 157 to 440 days). All-cause death occurred in 146 patients (2.1%) of the beta-blocker group versus 59 patients (3.6%) of the no-beta-blocker group (p < 0.001). After 2:1 propensity-score matching, beta-blocker therapy was associated with a lower incidence of all-cause death (2.8% vs. 4.1%, adjusted hazard ratio: 0.46, 95% confidence interval: 0.27 to 0.78, p = 0.004). The association with better outcome of beta-blocker therapy in terms of all-cause death was consistent across various subgroups, including patients with relatively low-risk profiles such as ejection fraction >40% or single-vessel disease. Conclusions Beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI. Our results support the current American College of Cardiology/American Heart Association guidelines, which recommend long-term beta-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile.

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KW - beta-blocker

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