Association of Beta-Blocker Therapy at Discharge With Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Sep 26, 2014
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Authors:
Yang JH, Hahn JY, Song YB, et al.
Citation:
JACC Cardiovasc Interv 2014;7:592-601.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

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)?

Methods:

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.

Results:

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.

Conclusions:

The authors concluded that beta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI.

Perspective:

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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