Association Between Early Oral β-Blocker Therapy and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction With Mild-Moderate Heart Failure: Findings From the CCC-ACS Project.

Abstract

Background:

There are limited data available on the impact of early (within 24 h of admission) β-blocker therapy on in-hospital outcomes of patients with ST-elevation myocardial infarction (STEMI) and mild-moderate acute heart failure. This study aimed to explore the association between early oral β-blocker therapy and in-hospital outcomes.

Methods:

Inpatients with STEMI and Killip class II or III heart failure from the Improving Care for Cardiovascular Disease in China project (n = 10,239) were enrolled. The primary outcome was a combined endpoint composed of in-hospital all-cause mortality, successful cardiopulmonary resuscitation after cardiac arrest, and cardiogenic shock. Inverse-probability-of-treatment weighting, multivariate Cox regression, and propensity score matching were performed.

Results:

Early oral β-blocker therapy was administered to 56.5% of patients. The incidence of the combined endpoint events was significantly lower in patients with early therapy than in those without (2.7 vs. 5.1%, P < 0.001). Inverse-probability-of-treatment weighting analysis demonstrated that early β-blocker therapy was associated with a low risk of combined endpoint events (HR = 0.641, 95% CI: 0.486-0.844, P = 0.002). Similar results were shown in multivariate Cox regression (HR = 0.665, 95% CI: 0.496-0.894, P = 0.007) and propensity score matching (HR = 0.633, 95% CI: 0.453-0.884, P = 0.007) analyses. A dose-response trend between the first-day β-blocker dosages and adverse outcomes was observed in a subset of participants with available data. No factor could modify the association of early treatment and the primary outcomes among the subgroups analyses.

Conclusion:

Based on nationwide Chinese data, early oral β-blocker therapy is independently associated with a lower risk of poor in-hospital outcome in patients with STEMI and Killip class II or III heart failure.

• Authors: Miao Wang, Jing Liu, Jun Liu, Yongchen Hao, Na Yang, Tong Liu, Sidney C Smith Jr, Yong Huo, Gregg C Fonarow, Junbo Ge, Louise Morgan, Changsheng Ma, Yaling Han, Dong Zhao, Siyan Zhan
• Journal: Frontiers in cardiovascular medicine (Front Cardiovasc Med) Vol. 9 Pg. 828614 ( 2022) ISSN: 2297-055X [Print] Switzerland
• PMID: 35497978 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Wang, Liu, Liu, Hao, Yang, Liu, Smith, Huo, Fonarow, Ge, Morgan, Ma, Han, Zhao and Zhan.