Effect of beta-blocker dose on mortality after acute coronary syndrome

Raposeiras‐Roubín, Sergio; Abu-Assi, Emad; Caneiro‐Queija, Berenice; Cobas-Paz, Rafael; Riobóo‐Lestón, Lucía; Rodriguez, Cristina; Lemos, Cruz Giraldez; Vidal, María Blanco; Guillán, Beatriz Ogando; Pérez-Martínez, Isabel; Paredes-Galán, Emilio; Jiménez-Díaz, Víctor Alfonso; Baz-Alonso, José Antonio; Calvo-Iglesias, Francisco; Íñiguez‐Romo, Andrés

doi:10.1016/j.repce.2017.06.020

Cited by 2 publications

(5 citation statements)

References 23 publications

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“…10,23 The true impact of beta-blocker therapy in current post-MI patients has been questioned, and a new investigation regarding beta-blocker therapy is frequently sought. 10,11,19,[24][25][26] In the current paper, post-ACS mrEF patients seem to represent an intermediate risk group, regarding past clinical history, coronary anatomy and inhospital mortality rate. This is in line with previously published studies regarding this population.…”

Section: Discussionmentioning

confidence: 75%

“…In this trial, beta-blocker dosage was not registered, but recent trials in European populations have identified no difference in higher versus lower doses. 11 The benefit of being started on a therapy de novo may be greater than the effect calculated by the model, as improvements may have already occurred 32our multivariate model included previous medication information in order to attenuate this difference.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, main beta-blocker studies were performed in the pre-revascularisation era and their role in post-myocardial infarction (MI) patients treated according to contemporary practice, with revascularisation performed on a large scale has been questioned. [8][9][10][11][12][13] LVEF assessed at post-ACS admission has been proved as one of the major prognostic markers, [14][15][16] but no trials have studied the role of drugs to improve clinical prognosis on the post-ACS mrEF population. 12 In the present research we aim to clarify which therapeutic decisions are independent predictors for inhospital survival, according to patients' post-ACS ejection fraction categories.…”

Section: Introductionmentioning

confidence: 99%

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Beta-blockers for post-acute coronary syndrome mid-range ejection fraction: a nationwide retrospective study

Sá¹,

Carvalho²,

Ruivo³

et al. 2019

European Heart Journal: Acute Cardiovascular Care

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Background: Patients with mid-range ejection fraction (40–49%) are in focus due to the newly defined entity of heart failure with mid-range ejection fraction. Acute coronary syndromes are a major aetiology for heart failure with mid-range ejection fraction. We aim to evaluate which therapeutic decisions are associated with inhospital survival benefit in post-acute coronary syndrome patients categorised according to the ejection fraction. Methods and results: The authors analysed a cohort of a multicentre national registry enrolling acute coronary syndrome patients between 2010 and 2016, classified according to their ejection fraction before hospital discharge. Patients with previously known heart failure or with no ejection fraction evaluation were excluded. A total of 9429 patients were included and categorised in three groups: (a) ejection fraction of 50% or greater ( n=6113, 65%); (b) ejection fraction of 40–49% ( n=1926, 20%); and (c) ejection fraction less than 40% ( n=1390, 15%). The primary endpoint was inhospital mortality. To eliminate confounding factors, a multivariate logistic regression analysis was conducted, including acute coronary syndrome type, baseline characteristics, pharmacological treatment, clinical data, laboratory data and coronary anatomy when known. The overall inhospital mortality was 2.8% ( n=263): 0.9% ( n=53) in group 1, 2.4% ( n=37) in group 2 and 11.4% ( n=159) in group 3. After multivariate analysis, an invasive strategy had a positive impact in all groups, inhospital beta-blocker administration had a positive impact for groups 2 and 3, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and spironolactone had a positive impact on group 3. Conclusion: Post-acute coronary syndrome mid-range ejection fraction patients represent an intermediate risk group in which beta-blocker administration was associated with inhospital survival benefit. An invasive strategy was a survival predictor for all groups, regardless of ejection fraction category.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Beta-blockers for post-acute coronary syndrome mid-range ejection fraction: a nationwide retrospective study

Sá¹,

Carvalho²,

Ruivo³

et al. 2019

European Heart Journal: Acute Cardiovascular Care

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“…When 50 patients who died due to CV events are distributed according to their diagnoses, 13 (3.8%) of 339 patients were diagnosed with UAP (mean follow-up of 30.02 ± 7.41 months), 19 (9,2%) of 206 patients with NSTEMI (mean follow-up of 30 ± 9.21 months), and 18 (5.1%) of 356 patients with STEMI (mean follow-up of 29.86 ± 8.62 months). During follow-up, 26% (13) of CVrelated deaths were seen in the UAP group, 38% (19) in the NSTEMI group, and 36% (18) In hospital Mortality of Acute Coronary Syndrome worse in the NSTEMI group. The frequency of death, re-infarction, stroke and CABG was found to be higher in the NSTEMI group (p < 0.0001).…”

Section: Discussion Discussionmentioning

confidence: 97%

“…However, there are also publications in the literature showing that there may not be a long-term reduction in mortality with the use of high-dose titrated betablockers after ACS. 18 Given the lack of strong randomized controlled trial on the duration of beta-blocker usage in post-MI patients, a more personalized approach should be adopted (based on the LVEF, arrhythmias, etc). If the LVEF is low (< 40%), beta-blockers should be used for longer periods of time.…”

Section: Discussion Discussionmentioning

confidence: 99%

Retrospective Evaluation of In-Hospital and Thirty-Month Mortality Parameters in Cases of Acute Coronary Syndrome

ALAN

KAYIKÇIOĞLU

ALAN

2022

DAHUDER Medical Journal

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Objectives: The aim of this study is to retrospectively assess, from the hospital records of patients, the clinical data of patients and the treatment strategies practiced on patients who were diagnosed as Acute Coronary Syndrome (ACS) and hospitalized and treated in the Hospital of Faculty of Medicine to research the effect of these data on occurrence of cardiovascular events and 30 months mortality. Methods: It is a retrospective screening study in which patients hospitalized with the diagnosis of ACS between June 2007 and December 2008 in the Hospital of Faculty of Medicine Cardiology Clinic are evaluated by using patient file information and electronic data recording system information, and by calling patients. In-hospital and long-term follow-up deaths were the endpoints of the study. Statistical analysis was performed using SPSS (Version 15.0). Results: 985 patients were included in the study who were diagnosed as ACS, hospitalized and treated in the hospital. The categorization of the patients subjected to the analysis (n:901) according to their diagnosis is as follows: 339 (38%) cases diagnosed as UAP, 206 (23%) cases diagnosed as NSTEMI, and 356 (39%) cases diagnosed as STEMI. 78,4 % of cases were male while 21,6 % were female. It was found that cases with hypertension, hyperlipidemia, obesity risk factor, and with a history of cardiovascular disease fall into the NSTEMI and UAP groups with a larger proportion. Among the groups, the UAP diagnosed cases have the largest and the STEMI diagnosed cases have the smallest ratio of using medicine groups such as beta blocker, calcium-canal blocker, ACE inhibitor, ARB, diuretic, statin, fibrate and nitrate before being hospitalized. In-hospital mortality was frequently encountered with a percentage of 7.6 % in STEMI cases, 2.4 % in NSTEMI cases, and 0.6 % in UAP cases. 30-months of follow-up data were obtained in all diagnosis groups for long-term mortality assessment. 70 (7.8 %) deaths were observed within the follow-up. According to diagnosis groups, death was observed in 22 (6.5 %) of UAP cases, 22 (10.7 %) of NSTEMI cases, and 26 (7.3 %) of STEMI cases. Correlation between long-term survival (30 months) and in-hospital statin usage and statin usage in discharge was not significant (p value respectively 0.1 and 0.16). Correlation between an approximate 30-months-survival and in-hospital ACE inhibitor/ARB inhibitor usage and ACE inhibitor/ARB inhibitor usage during discharge was significant (p = 0.007 and p = 0.004). It is also found that there was a significant correlation between survival in the same period of time and in-hospital beta blocker usage (p = 0.01). There was not a significant correlation between beta blocker usage during discharge and long-term survival (p = 0.779). Conclusion: Results of the unicentral retrospective scanning study which involves 901 ACS diagnosed patients prove to be similar to the ones obtained from GRACE and Euro Heart Survey prospective studies which were carried out in multi-central environment and among outnumbered patients.

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Effect of beta-blocker dose on mortality after acute coronary syndrome

Cited by 2 publications

References 23 publications

Beta-blockers for post-acute coronary syndrome mid-range ejection fraction: a nationwide retrospective study

Beta-blockers for post-acute coronary syndrome mid-range ejection fraction: a nationwide retrospective study

Retrospective Evaluation of In-Hospital and Thirty-Month Mortality Parameters in Cases of Acute Coronary Syndrome

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