Association of Beta-Blocker Therapy at Discharge With Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
What is the benefit of beta-blockers in patients with ST-segment elevation myocardial infarction (STEMI) who are treated with primary percutaneous coronary intervention (PCI)?
The authors assessed the outcome of 8,510 patients who presented with STEMI in Korea and were discharged alive after undergoing primary PCI. Patients were classified 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 performed in 1,325 patient triplets. The primary outcome was all-cause death.
The median follow-up duration was 367 days. Use of beta-blockers was associated with a lower all-cause mortality (2.1% vs. 3.6%, p < 0.001). In the propensity-matched cohort, 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, 0.27-0.78; 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.
The authors concluded that beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI.
The evidence for use of beta-blockers in patients treated with re-perfusion therapy is weak, although there is strong endorsement for this therapy in the current guidelines. The magnitude of benefit in association with beta-blockers that was observed in this study belies biological plausibility, and it is more likely to reflect residual confounding than a true benefit. Nevertheless, it is unlikely that we will see a randomized trial to test the role of beta-blockers in patients successfully treated with primary PCI in the near future, and this therapy is going to remain a standard part of guideline-supported therapy primarily based on data from the pre-fibrinolytic era.
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