Beta-blockers and Short-Term Cardiovascular Outcomes In Patients Hospitalized For Acute Coronary Syndrome and a Left Ventricular Ejection Fraction ≥40%

Abstract

Beta-blockers (BB) have been traditionally associated with improvement in cardiovascular disease outcomes in patients with ischemic cardiomyopathy. Whether they're still efficacious in the postreperfusion era is currently debated in the light of recent controversial reports. In-hospital, 6-month and 12-month mortality were studied in the GULF-COAST, a prospective multicenter cohort of acute coronary syndrome (ACS), in relation to BB use: prior to admission, 24-hour post-admission and on discharge in patients with a left ventricular ejection fraction (LVef) ≥ 40%. On admission, 50.9% of the cohort participants had a LVef ≥ 40%, of whom 1203 (55.4%) were on BB whilst 905 (44.6%) were not. Mean age was 60 (13) years old and 66% were males. Prior BB use or its administration in 24 hours decreased in-hospital mortality (OR = 0.25, 95% CI [0.09-0.67]; OR = 0.16, 95% CI [0.08-0.35]; respectively). BB on discharge lowered 1-month mortality (OR = 0.28, 95% CI [0.11-0.72]), but had a neutral effect on mortality, reinfarction and stroke at 6 and 12 months. Results were unchanged after multivariable adjustments and further sensitivity analysis. In this retrospective cohort of ACS, BB improved in-hospital and 1-month mortality in patients with a LVEF ≥ 40% but had a neutral effect on longer-term outcome.Several trials conducted in the late 1970's and 1980's, such as ISIS-1 (First International Study of Infarct Survival) 1 and BHAT (Beta-Blocker Heart Attack Trial) 2 , showed that beta blockers (BB) decrease mortality after myocardial infarction (MI). An earlier meta-analysis of studies in which MI patients were treated with BB reported a 25 percent reduction in one-year mortality 3 .The treatment of ischemic cardiomyopathy has been revolutionized during the past 2 decades with the introduction of new treatment regimens such as dual anti-platelets, statins and most importantly reperfusion therapy. Progressively, the long-term protective role of BB in MI, once vital, is being questioned. A large metanalysis that included over 100 000 MI patients showed that BB reduce mortality in the pre-reperfusion era but failed to report any long-term survival benefit of BB in trials performed in the post-reperfusion era 4 .There is still convincing evidence that BB use is beneficial on the short-term outcome. A 2013 meta-analysis of randomized trials concluded that early BB therapy in ACS patients reduces in-hospital mortality, re-infarction and arrhythmias 5 . Nevertheless, it is not known how long BB treatment beneficial post-ACS is. In this paper, we report that previous BB therapy and/or BB treatment up to 24 hours after admission is associated with improved in-hospital outcome. However, BB therapy on discharge was associated only with decreased 1-month mortality, with no effect on mortality at 6 and 12 months. measures and baseline patients' characteristics were compared between the two groups: BB versus no BB using the χ 2 test (or Fisher's exact test when expected cell counts fell below 5) for categorical variables and the student's ...

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