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Should we still use beta-blockers in all patients after ST-segment elevation acute myocardial infarction?
Session:
Painel 6-Doença Coronária 1
Speaker:
João André Ferreira
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
João André Ferreira; Sílvia Monteiro; Rui Baptista; Lino Gonçalves; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p>Background: Beta-blockers (BBs) were initially developed in the 1960s for the treatment of angina pectoris. Nowadays they have a much larger therapeutic spectrum. The benefit of long-term treatment with oral BBs after acute myocardial infarction with ST-segment elevation (STEMI) was established in the pre-reperfusion era, almost 20 years ago and, today, controversy remains regarding the need for beta-blockers as well as treatment duration after patient release. <br /> <br /> Purpose: To determine the association between BBs use and mortality after discharge in STEMI patients with preserved, mid-range and reduced left ventricular ejection fraction (LVEF).<br /> <br /> Methods: We analysed data from 12.954 adult patients admitted to hospital for STEMI from 2010 to 2019. Patients with i) no information regarding left ventricular ejection fraction (LVEF) during hospitalisation, ii) hospitalisation in the previous 24 hours iii) death during hospitalisation iv) no follow-up information at 6 or 12 months v) previously known heart failure or acute myocardial infarction and v) no information regarding the use of BBs were excluded. We looked into the impact of BBs after discharge on all-cause mortality and on a composite outcome of all-cause mortality and cardiovascular re-admission at 6 and 12 months.</p> <p>Results: 3145 patients were included in the analysis, of which 2526 (80.3%) received BBs after discharge. A total of 5% of patients died (n=121) and 13.5% (n=202) registered an hospital re-admission of cardiovascular cause in 1 year. After nonadjusted Cox regression analysis, use of BB after discharge was associated with a significant reduced mortality at 1 year (HR 0.499, IC95% 0.353-0.705, p<0.001) and mortality and re-admission for CV cause at 1 year (HR 0.690, IC95% 0.550-0.865, p=0.001). However, after adjustment for important comorbidities, age, intra-hospitalar complications, discharge drugs and heart failure signs during hospitalisation, BB use after discharge was not associated with better survival at 1 year (HR 0.70, IC95% 0.37-1.33, p=0.276) and survival or re-admission of CV cause at 1 year (HR 0.73, IC95% 0.51-1.04, p=0.081). Despite our findings, after distribution of patients between LVEF groups (<40%, 40-50% and >50%), we found important differences in survival or re-admission of CV cause at 1 year in patients with LVEF <40% (HR 0.43, IC95% 0.26-0.70, p=0.001), while reduction in events did not happen in patients with LVEF 40-50% (HR 1.01, IC 95% 0.64-1.60, p=0.959) nor in patients with LVEF >50% (HR 0.73, IC 0.51-1.04, p=0.081).<br /> <br /> Conclusions: Despite having a class IIa indication in the most recent european STEMI guidelines and a class I indication in the american guidelines, the systematic use of BBs following STEMI was not associated with better survival after long-term follow-up in patients with mid-range or preserved LVEF.</p>
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