Admission Heart Rate Is a Determinant of Effectiveness of Beta-Blockers in Acute Myocardial Infarction Patients.

Abstract

BACKGROUND:

Beta-blockers are standard therapy for acute myocardial infarction (AMI). However, despite current advances in the management of AMI, it remains unclear whether all AMI patients benefit from β-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of β-blockers for AMI patients. Methods and Results: We enrolled 3,283 consecutive AMI patients who were admitted to 28 participating institutions in the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) study. According to admission HR, we divided patients into 3 groups: bradycardia (HR <60 beats/min, n=444), normocardia (HR 60 to ≤100 beats/min, n=2,013), and tachycardia (HR >100 beats/min, n=342). The primary endpoint was major adverse cardiac events (MACE), including all-cause death, non-fatal MI, non-fatal stroke, heart failure (HF), and urgent revascularization for unstable angina, at 3-year follow-up. Beta-blocker at discharge was significantly associated with a lower risk of MACE in the tachycardia group (23.6% vs. 33.0%; P=0.033), but it did not affect rates of MACE in the normocardia group (17.8% vs. 18.4%; P=0.681). In the bradycardia group, β-blocker use at discharge was significantly associated with a higher risk of MACE (21.6% vs. 12.7%; P=0.026). Results were consistent for multivariable regression and stepwise multivariable regression.

CONCLUSIONS:

Admission HR might determine the efficacy of β-blockers for current AMI patients.

• Authors: Taishi Okuno, Jiro Aoki, Kengo Tanabe, Koichi Nakao, Yukio Ozaki, Kazuo Kimura, Junya Ako, Teruo Noguchi, Satoshi Yasuda, Satoru Suwa, Kazuteru Fujimoto, Yasuharu Nakama, Takashi Morita, Wataru Shimizu, Yoshihiko Saito, Atsushi Hirohata, Yasuhiro Morita, Teruo Inoue, Atsunori Okamura, Toshiaki Mano, Kazuhito Hirata, Yoshisato Shibata, Mafumi Owa, Kenichi Tsujita, Hiroshi Funayama, Nobuaki Kokubu, Ken Kozuma, Shiro Uemura, Tetsuya Tobaru, Keijiro Saku, Shigeru Ohshima, Kunihiro Nishimura, Yoshihiro Miyamoto, Hisao Ogawa, Masaharu Ishihara, J-MINUET Investigators
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 83 Issue 5 Pg. 1054-1063 (04 25 2019) ISSN: 1347-4820 [Electronic] Japan
• PMID: 30930346 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Chemical References

• Adrenergic beta-Antagonists

Topics

• Adrenergic beta-Antagonists (administration & dosage)
• Aged
• Female
• Follow-Up Studies
• Heart Rate
• Humans
• Male
• Middle Aged
• Myocardial Infarction (drug therapy, mortality)
• Patient Admission