Beta-Blocker Use after Discharge in Patients with Acute Myocardial Infarction in the Contemporary Reperfusion Era.
Mengjin HuSong HuXiaojin GaoYue-Jin YangPublished in: Medicina (Kaunas, Lithuania) (2022)
Background and objectives: The effect of beta-blocker use after discharge on patients with acute myocardial infarction (AMI) in the contemporary reperfusion era remains ambiguous. By applying meta-analysis, we sought to assess the role of beta-blockers in the contemporary reperfusion era. Materials and Methods: Randomized controlled trials (RCT) and observational studies using propensity score matching, comparing use of beta-blockers with non-use of beta-blockers, in patients with AMI after discharge. The primary outcome was all-cause mortality. Odds ratios (OR) and associated 95% confidence intervals (CI) were calculated. Results : One RCT and eight observational studies, containing 47,339 patients with AMI, were included. Compared with non-use of beta-blockers, beta-blocker use after discharge may have reduced the risk of all-cause mortality (OR: 0.70, 95% CI: 0.61 to 0.80, I 2 = 14.4%), cardiac death (OR: 0.63, 95% CI: 0.44 to 0.91, I 2 = 22.8%), myocardial infarction (OR: 0.73, 95% CI: 0.62 to 0.86, I 2 = 0), and revascularization (OR: 0.92, 95% CI: 0.85 to 0.99, I 2 = 0). No significant differences were found in major adverse cardiovascular events (MACE, OR: 0.88, 95% CI: 0.66 to 1.17, I 2 = 78.4%), heart failure (OR: 0.56, 95% CI: 0.29 to 1.08, I 2 = 0) or stroke (OR: 1.13, 95% CI: 0.92 to 1.39, I 2 = 0). For patients with preserved left ventricular function, beta-blocker use after discharge may have also reduced the risk of all-cause mortality (OR: 0.61, 95% CI: 0.44 to 0.84, I 2 = 0). Conclusions : Use of beta-blockers after discharge may still be beneficial for AMI patients in the contemporary reperfusion era, with or without preserved left ventricular function.
Keyphrases
- acute myocardial infarction
- left ventricular
- angiotensin converting enzyme
- percutaneous coronary intervention
- heart failure
- cardiovascular events
- randomized controlled trial
- systematic review
- coronary artery disease
- cerebral ischemia
- angiotensin ii
- chronic kidney disease
- cardiac resynchronization therapy
- left atrial
- cardiovascular disease
- type diabetes
- end stage renal disease
- emergency department
- coronary artery bypass grafting
- aortic stenosis
- newly diagnosed
- blood brain barrier
- ejection fraction
- patient reported
- peritoneal dialysis
- meta analyses
- acute ischemic stroke
- study protocol
- drug induced