CLINICAL RESEARCH: BETA-BLOCKERS IN MYOCARDIAL INFARCTION
Does beta-blocker therapy improve clinical outcomes of acute myocardial infarction after successful primary angioplasty?
Steven J. Kernis, MD*,*,
Kishore J. Harjai, MD, FACC*,
Gregg W. Stone, MD, FACC ,
Lorelei L. Grines, PhD*,
Judith A. Boura, MS*,
William W. O'Neill, MD, FACC* and
Cindy L. Grines, MD, FACC*
* Cardiology Division, William Beaumont Hospital, Royal Oak, Michigan, USA
Cardiology Division, Lenox Hill Hospital, New York, New York, USA
Manuscript received August 12, 2003;
revised manuscript received September 19, 2003,
accepted September 23, 2003.
* Reprint requests and correspondence: Dr. Steven J. Kernis, William Beaumont Hospital Cardiology, 28829 West King William, Farmington Hills, Michigan 48331, USA.
skernis{at}beaumont.edu
OBJECTIVES: We sought to determine if beta-blocker therapy improves clinical outcomes of acute myocardial infarction (AMI) after successful primary percutaneous coronary intervention (PCI).
BACKGROUND: We have shown that pre-treatment with beta-blockers has a beneficial effect on short-term clinical outcomes in patients undergoing primary PCI for AMI. It is unknown if beta-blocker therapy after successful primary PCI improves prognosis of AMI.
METHODS: We analyzed clinical, angiographic, and outcomes data in 2,442 patients who underwent successful primary PCI in the Primary Angioplasty in Acute Myocardial Infarction-2 (PAMI-2), PAMI No Surgery-on-Site (PAMI noSOS), Stent PAMI, and Air PAMI trials. We classified patients into beta group (those who received beta-blockers after successful PCI, n = 1,661) and no-beta group (n = 781). We compared death and major adverse cardiac events (MACE) (death, reinfarction, and ischemia-driven target vessel revascularization) at six months between groups receiving and not receiving beta-blockers.
RESULTS: At six months, beta patients were less likely to die (2.2% vs. 6.6%, p < 0.0001) or experience MACE (14 vs. 17%, p = 0.036). In multivariate analysis, beta-blockers were independently associated with lower six-month mortality (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.26 to 0.73, p = 0.0016). Beta-blocker therapy was an independent predictor of lower six-month events in high-risk subgroups: ejection fraction  50% (death: OR 0.34, 95% CI 0.19 to 0.60, p = 0.0002) or multi-vessel coronary artery disease (CAD) (death: OR 0.26, 95% CI 0.14 to 0.48, p < 0.0001; MACE: OR 0.57, 95% CI 0.41 to 0.80, p = 0.0011).
CONCLUSIONS: Treatment with beta-blockers after successful primary PCI is associated with reduced six-month mortality, with the greatest benefit in patients with a low ejection fraction or multi-vessel CAD.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CABG | = coronary artery bypass grafting | | CAD | = coronary artery disease | | IRA | = infarct-related artery | | I-TVR | = ischemia driven target vessel revascularization | | LVEF | = left ventricular ejection fraction | | MACE | = major adverse cardiac events | | PAMI | = Primary Angioplasty in Acute Myocardial Infarction | | PCI | = percutaneous coronary intervention | | PVD | = peripheral vascular disease | | RCA | = right coronary artery | | TIMI | = Thrombolysis in Myocardial Infarction |
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