β-Blocker Therapy Prior to Admission for Acute Coronary Syndrome in Patients Without Heart Failure or Left Ventricular Dysfunction Improves In-Hospital and 12-Month Outcome: Results From the GULF-RACE 2 (Gulf Registry of Acute Coronary Events-2).

Abstract

BACKGROUND:

The prognostic impact of β-blockers (BB) in acute coronary syndrome (ACS) patients without heart failure (HF) or left ventricular dysfunction is controversial, especially in the postreperfusion era. We sought to determine whether a BB therapy before admission for ACS has a favorable in-hospital outcome in patients without HF, and whether they also reduce 12-month mortality if still prescribed on discharge.

METHODS AND RESULTS:

The GULF-RACE 2 (Gulf Registry of Acute Coronary Events-2) is a prospective multicenter study of ACS in 6 Middle Eastern countries. We studied in-hospital cardiovascular events in patients hospitalized for ACS without HF in relation to BB on admission, and 1-year mortality in relation to BB on discharge. Among the 7903 participants, 7407 did not have HF, of whom 5937 (80.15%) patients were on BB. Patients on BB tended to be older and have more comorbidities. However, they had a lower risk of in-hospital mortality, mitral regurgitation, HF, cardiogenic shock, and ventricular tachycardia/ventricular fibrillation. Furthermore, 4208 patients were discharged alive and had an ejection fraction ≥40%. Among those, 84.1% had a BB prescription. At 12 months, they also had a reduced risk of mortality as compared with the non-BB group. Even after correcting for confounding factors in 2 different models, in-hospital and 12-month mortality risk was still lower in the BB group.

CONCLUSIONS:

In this cohort of ACS, BB therapy before admission for ACS is associated with decreased in-hospital mortality and major cardiovascular events, and 1-year mortality in patients without HF or left ventricular dysfunction if still prescribed on discharge.

• Authors: Charbel Abi Khalil, Khalid F AlHabib, Rajvir Singh, Nidal Asaad, Hussam Alfaleh, Alawi A Alsheikh-Ali, Kadhim Sulaiman, Mostafa Alshamiri, Fayez Alshaer, Wael AlMahmeed, Jassim Al Suwaidi
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 6 Issue 12 (Dec 20 2017) ISSN: 2047-9980 [Electronic] England
• PMID: 29263035 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Chemical References

• Adrenergic beta-Antagonists

Topics

• Acute Coronary Syndrome (drug therapy, mortality, physiopathology)
• Adrenergic beta-Antagonists (therapeutic use)
• Female
• Follow-Up Studies
• Heart Failure
• Hospital Mortality (trends)
• Hospitalization (trends)
• Humans
• Male
• Middle Aged
• Middle East (epidemiology)
• Prognosis
• Prospective Studies
• Registries
• Survival Rate (trends)
• Ventricular Dysfunction, Left
• Ventricular Function, Left (physiology)