Beta Blocker Use After Acute Myocardial Infarction in the Patient with Normal Systolic Function: When is it “Ok” to Discontinue?

Kezerashvili, Anna; Marzo, Kevin; Leon, Joshua De

doi:10.2174/157340312801215764

Cited by 64 publications

(33 citation statements)

References 48 publications

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“…If patients are experiencing side effects from ␤-blocker use, it may be reasonable to discontinue therapy at least 1 year after an MI (strength of recommendation B). 35 For patients who are unable to take ␤-blockers and experience recurrent ischemia, consideration should be given to starting a nondihydropyridine calcium channel blocker (ie, verapamil or diltiazem) in the absence of clinically significant left ventricular dysfunction (strength of recommendation A). …”

Section: Adjuvant Agents ␤-Blockersmentioning

confidence: 99%

Diagnosis and Management of Acute Coronary Syndrome: An Evidence-Based Update

Smith¹,

Negrelli²,

Manek³

et al. 2015

The Journal of the American Board of Family Medicine

127

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Acute coronary syndrome (ACS) describes the range of myocardial ischemic states that includes unstable angina, non-ST elevated myocardial infarction (MI), or ST-elevated MI. ACS is associated with substantial morbidity and mortality and places a large financial burden on the health care system. The diagnosis of ACS begins with a thorough clinical assessment of a patient's presenting symptoms, electrocardiogram, and cardiac troponin levels as well as a review of past medical history. Early risk stratification can assist clinicians in determining whether an early invasive management strategy or an initial conservative strategy should be pursued and can help determine appropriate pharmacologic therapies. Key components in the management of ACS include coronary revascularization when indicated; prompt initiation of dual antiplatelet therapy and anticoagulation; and consideration of adjuvant agents including ␤ blockers, inhibitors of the renin angiotensin system, and HmG-coenzyme A reductase inhibitors. It is essential for clinicians to take an individualized approach to treatment and consider long-term safety and efficacy when managing patients with a history of ACS after hospital discharge. The term myocardial infarction (MI) is used when there is evidence of myocardial necrosis in the setting of acute myocardial ischemia. STEMI is differentiated from NSTEMI by the presence of persistent ECG findings of ST segment elevation. 3In recent years, progress has been made in the management of ACS, particularly related to optimizing pharmacotherapy. 2,3 Family physicians care for patients presenting with ACS in office as well as emergency settings and play an important role in both acute and long-term management of such patients. In this article, we review the topic of ACS with particular emphasis on initial management and use of the newer medications. Specific coronary interventions performed by the cardiologist (eg, stents or balloon angioplasty) are beyond the scope of this review. Scope of the ProblemCoronary heart disease (CHD) is responsible for more than half of all cardiovascular events in individuals less than 75 years of age. The prevalence of This article was externally peer reviewed.

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Section: Adjuvant Agents ␤-Blockersmentioning

confidence: 99%

Diagnosis and Management of Acute Coronary Syndrome: An Evidence-Based Update

Smith¹,

Negrelli²,

Manek³

et al. 2015

The Journal of the American Board of Family Medicine

127

View full text Add to dashboard Cite

show abstract

“…While clear benefit exists for ACE inhibitor and ARB therapy in patients with nephropathy or hypertension, the benefits in patients with CVD in the absence of these conditions are less clear, especially when LDL cholesterol is concomitantly controlled (75,76). In patients with a prior MI, b-blockers should be continued for at least 2 years after the event (77). A systematic review of 34,000 patients showed that metformin is as safe as other glucose-lowering treatments in patients with diabetes and CHF, even in those with reduced left ventricular ejection fraction or concomitant chronic kidney disease; however, metformin should be avoided in hospitalized patients (78 …”

Section: Lifestyle and Pharmacological Interventionsmentioning

confidence: 99%

8. Cardiovascular Disease and Risk Management

2014

Diabetes Care

209

104

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“…Many randomized controlled studies and meta-analyses have shown the benefits of β-blockers on the clinical outcomes in STEMI patients [1][2][3][4][5][6] . However, confidence about the benefit of β-blockers has weakened in low-risk STEMI patients, as the clinical outcomes of STEMI have improved due to generalized primary percutaneous coronary intervention (PCI) and advances of medical treatment, such as anti-platelet agents, angiotensin-converting enzyme inhibitors and statins [7] . Especially, the positive effects of β-blockers can be offset more in Asian people than in Caucasians because of the susceptibility of Asians to the adverse effects of β-blockers.…”

Section: Introductionmentioning

confidence: 99%

β-Blocker Therapy in the Era of Primary Percutaneous Intervention for ST Elevation Myocardial Infarction

Lee¹,

Park²,

Tahk³

et al. 2015

Cardiology

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Objectives: With the present therapeutic advances in the era of primary percutaneous coronary intervention (PCI), the role of β-blockers in ST elevation acute myocardial infarction (STEMI) has remained contentious. Methods: We analyzed the data and clinical outcomes of 901 STEMI patients who had undergone primary PCI. We classified the patients into β-blocker (n = 598) and non-β-blocker groups (n = 303). Results: The cumulative incidence of all-cause death was 10.0% in the β-blocker group and 25.4% in the non-β-blocker group (p < 0.001). The incidence of major adverse cardiac events (MACE) was 22.1% in the β-blocker group and 34.3% in the non-β-blocker group (p < 0.001). The relative hazard ratio (HR) of β-blockers for all-cause death and MACE with low left ventricle ejection fraction (LVEF; <50%) was 0.55 [95% confidence interval (CI) 0.35-0.86, p = 0.009] and 0.75 (95% CI 0.51-1.09, p = 0.125), respectively. In patients with normal LVEF (≥50%), the relative HR of β-blockers for death and MACE were 0.50 (95% CI 0.29-0.88, p = 0.016) and 0.75 (95% CI 0.51-1.12, p = 0.162), respectively. After propensity score matching of the difference of the baseline characteristics, the Kaplan-Meier survival curve demonstrated lower mortality in the β-blocker group than in the non-β-blocker group with both low LVEF and normal LVEF (p = 0.02 and p = 0.001, respectively). Conclusions: β-Blockers have beneficial clinical outcomes in the era of primary PCI for STEMI, regardless of the LVEF.

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Beta Blocker Use After Acute Myocardial Infarction in the Patient with Normal Systolic Function: When is it “Ok” to Discontinue?

Cited by 64 publications

References 48 publications

Diagnosis and Management of Acute Coronary Syndrome: An Evidence-Based Update

Diagnosis and Management of Acute Coronary Syndrome: An Evidence-Based Update

8. Cardiovascular Disease and Risk Management

β-Blocker Therapy in the Era of Primary Percutaneous Intervention for ST Elevation Myocardial Infarction

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