Aims We aimed to investigate the long-term cardio-protective effect associated with beta-blocker (BB) treatment in stable, optimally treated myocardial infarction (MI) patients without heart failure (HF). Methods and results Using nationwide registries, we included patients with first-time MI undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) during admission and treated with both acetyl-salicylic acid and statins post-discharge between 2003 and 2018. Patients with prior history of MI, prior BB use, or any alternative indication or contraindication for BB treatment were excluded. Follow-up began 3 months following discharge in patients alive, free of cardiovascular (CV) events or procedures. Primary outcomes were CV death, recurrent MI, and a composite outcome of CV events. We used adjusted logistic regression and reported standardized absolute risks and differences (ARD) 3 years after MI. Overall, 30 177 stable, optimally treated MI patients were included (58% acute PCI, 26% sub-acute PCI, 16% CAG without intervention). At baseline, 82% of patients were on BB treatment (median age 61 years, 75% male) and 18% were not (median age 62 years, 68% male). BB treatment was associated with a similar risk of CV death, recurrent MI, and the composite outcome of CV events compared with no BB treatment [ARD (95% confidence intervals)] correspondingly; 0.1% (−0.3% to 0.5%), 0.2% (−0.7% to 1.2%), and 1.2% (−0.2% to 2.7%). Conclusions In this nationwide cohort study of stable, optimally treated MI patients without HF, we found no long-term effect of BB treatment on CV prognosis following the patients from 3 months to 3 years after MI admission.

ObjectiveGastrointestinal bleeding (GIB) risk in relation to concomitant treatment with non-vitamin K oral anticoagulants (NOAC) and oral glucocorticoids is insufficiently explored. We aimed to investigate the short-term risk following coexposure.MethodsThis is a register-based, nationwide Danish study including patients with atrial fibrillation on NOACs during 2012–2018. Patients were defined as exposed to oral glucocorticoids if they claimed a prescription within 60 days prior to GIB. We investigated the associations between GIB and oral glucocorticoid exposure, reporting HRs via a nested case–control design and absolute risk via a cohort design. Matching terms were age, sex, calendar year, follow-up time and NOAC agent.Results98 376 patients on NOACs (median age: 75 years (IQR: 68–82), 44% female) were included, and 16% redeemed at least one oral glucocorticoid prescription within 3 years. HRs of GIB were increased comparing exposed with non-exposed patients (<20 mg daily dose, HR 1.54 (95% CI 1.29 to 1.84); ≥20 mg daily dose, HR 2.19 (95% CI 1.81 to 2.65)). 60-day standardised absolute risk of GIB following first claimed oral glucocorticoid prescription increased compared with non-exposed: 60-day absolute risk: 0.71% (95% CI 0.58% to 0.85%) vs 0.38% (95% CI 0.32% to 0.43%). The relative risk was elevated as well: risk ratio of 1.89 (95% CI 1.43 to 2.36).ConclusionsConcomitant treatment with NOACs and oral glucocorticoids was associated with a short-term rate and risk increase of GIB compared with patients only on NOACs. This could have implications for clinical management, necessitating closer monitoring or other risk mitigation strategies during episodes of cotreatment with oral glucocorticoids.

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Background Peripheral blood eosinophil count is liable to many factors and has variability over time. There are few studies on the association between the rise of blood eosinophils and the exacerbation incidence in stable chronic obstructive pulmonary disease (COPD) patients. The association between the rise of blood eosinophils and the rate of exacerbation in stable COPD patients is controversial. Objective To study the relationship between the count of eosinophils in the peripheral blood and the incidence of COPD exacerbation in stable patients. Patients and methods This prospective inquiry was done on 46 patients diagnosed as suffering from stable COPD ‘on the report of the global initiative for chronic obstructive lung disease (GOLD) guidelines’ attending Ain Shams University hospital outpatient clinic. Results Forty-six stable COPD patients were classified into two groups (groups A and B) based on their median eosinophilic count of ‘250 cell/μl.’ Patients with high eosinophil count ‘group A’ (>250 cell/μl) had a significantly higher incidence of exacerbations (P=0.003), with a relative risk ratio of 2.77, as well as a higher number of exacerbations per patient (two exacerbations/patient) versus one exacerbation/three patients (P<0.001), and a shorter period to the first exacerbation (17 vs. 31 days) (P=0.024), compared with those with low eosinophil count ‘group B (≤250 cell/μl)’ during the study period. On the contrary, there was no significant difference between them in the incidence of pneumonia in relation to inhaled corticosteroid use. Conclusion The count of eosinophils in the peripheral blood is a reliable exacerbation biomarker in stable COPD patients.