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beta-Blockers and Mortality After Acute Myocardial Infarction in Patients Without Heart Failure or Ventricular Dysfunction
Univ Leeds, Leeds Inst Cardiovasc & Metab Med, MRC, Bioinformat Ctr, Level 11,Worsley Bldg, Leeds LS2 9JT, W Yorkshire, England..
Univ Leeds, Leeds Inst Cardiovasc & Metab Med, MRC, Bioinformat Ctr, Level 11,Worsley Bldg, Leeds LS2 9JT, W Yorkshire, England..
Univ Leeds, Leeds Inst Hlth Sci, Leeds, W Yorkshire, England..
Karolinska Univ Hosp, Karolinska Inst, Dept Cardiol, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
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2017 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 69, no 22, p. 2710-2720Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: For acute myocardial infarction (AMI) without heart failure (HF), it is unclear if beta-blockers are associated with reduced mortality.

OBJECTIVES: The goal of this study was to determine the association between beta-blocker use and mortality in patients with AMI without HF or left ventricular systolic dysfunction (LVSD).

METHODS: This cohort study used national English and Welsh registry data from the Myocardial Ischaemia National Audit Project. A total of 179,810 survivors of hospitalization with AMI without HF or LVSD, between January 1, 2007, and June 30, 2013 (final follow-up: December 31, 2013), were assessed. Survival-time inverse probability weighting propensity scores and instrumental variable analyses were used to investigate the association between the use of beta-blockers and 1-year mortality.

RESULTS: Of 91,895 patients with ST-segment elevation myocardial infarction and 87,915 patients with non-ST-segment elevation myocardial infarction, 88,542 (96.4%) and 81,933 (93.2%) received beta-blockers, respectively. For the entire cohort, with> 163,772 person-years of observation, there were 9,373 deaths (5.2%). Unadjusted 1-year mortality was lower for patients who received beta-blockers compared with those who did not (4.9% vs. 11.2%; p < 0.001). However, after weighting and adjustment, there was no significant difference in mortality between those with and without beta-blocker use (average treatment effect [ATE] coefficient: 0.07; 95% confidence interval [CI]: -0.60 to 0.75; p = 0.827). Findings were similar for ST-segment elevation myocardial infarction (ATE coefficient: 0.30; 95% CI: -0.98 to 1.58; p = 0.637) and non-ST-segment elevation myocardial infarction (ATE coefficient: -0.07; 95% CI: -0.68 to 0.54; p = 0.819).

CONCLUSIONS: Among survivors of hospitalization with AMI who did not have HF or LVSD as recorded in the hospital, the use of beta-blockers was not associated with a lower risk of death at any time point up to 1 year.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2017. Vol. 69, no 22, p. 2710-2720
Keywords [en]
average treatment effect, NSTEMI, preserved left ventricular systolic function, propensity score, STEMI, survival
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-326203DOI: 10.1016/j.jacc.2017.03.578ISI: 000402134700005PubMedID: 28571635OAI: oai:DiVA.org:uu-326203DiVA, id: diva2:1130038
Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2017-08-08Bibliographically approved

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