Mortality reduction with use of oral beta-blockers in patients with acute coronary syndrome

Abstract

OBJECTIVES:Recent studies have revealed a relationship between beta-blocker use and worse prognosis in acute coronary syndrome, mainly due to a higher incidence of cardiogenic shock. However, the relevance of this relationship in the reperfusion era is unknown. The aim of this study was to analyze the outcomes of patients with acute coronary syndrome that started oral beta-blockers within the first 24 hours of hospital admission (group I) compared to patients who did not use oral beta-blockers in this timeframe (group II).METHODS:This was an observational, retrospective and multicentric study with 2,553 patients (2,212 in group I and 341 in group II). Data regarding demographic characteristics, coronary treatment and medication use in the hospital were obtained. The primary endpoint was in-hospital all-cause mortality. The groups were compared by ANOVA and the chi-square test. Multivariate analysis was conducted by logistic regression and results were considered significant when p<0.05.RESULTS:Significant differences were observed between the groups in the use of angiotensin-converting enzyme inhibitors, enoxaparin, and statins; creatinine levels; ejection fraction; tabagism; age; and previous coronary artery bypass graft. Significant differences were also observed between the groups in mortality (2.67% vs 9.09%, OR=0.35, p=0.02) and major adverse cardiovascular events (11% vs 29.5%, OR=4.55, p=0.02).CONCLUSIONS:Patients with acute coronary syndrome who underwent early intervention with oral beta-blockers during the first 24 hours of hospital admission had a lower in-hospital death rate and experienced fewer major adverse cardiovascular events with no increase in cardiogenic shock or sustained ventricular arrhythmias compared to patients who did not receive oral beta-blockers within this timeframe.

Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study

“…The other possible reason might be also, the patient took the medication, but it might lack documentation. This finding was in line with retrospective study from Brazil, where early initiation of beta-blocker had reduced in-hospital mortality by 8.12 times (95% CI:1.53-14.56) [51]. Similarly, from Switzerland Erne and his co-authors claimed that starting of beta-blockers had preventive effect of inhospital mortality by 2.174 times (AOR = 0.46, 95% CI:0.37-0.57) [52].…”

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

“…In a meta-analysis that included over 70 000 patients, early intravenous BB therapy during ACS reduced mortality, ventricular tachyarrhythmias and reinfarction. In a recent Brazilian observational study, oral BB use within the first 24 hours of ACS onset resulted in decreased in-hospital mortality 9 . Table 1.…”

Evaluation of management in acute coronary syndrome and extent of adherence to standard treatment guidelines

“…27 In the observational, retrospective and multi-centric study with 2,553 patients which was conducted by Soeiro et al, it was concluded that patients with acute coronary syndrome who underwent early intervention with oral beta-blockers during the first 24 hours of hospital admission had a lower in-hospital death rate and experienced fewer major adverse cardiovascular events with no increase in cardiogenic shock or sustained ventricular arrhythmias compared to patients who did not receive oral beta-blockers within this timeframe. 28 Data from the Unité de Soins Intensifs Coronaires (USIC) registry and the Swedish registry of cardiac intensive care also suggest that prehospital fibrinolytic therapy may lower STEMI mortality rates. 29 In the Euro heart survey of ACS, fibrinolytic (thrombolytic) therapy using streptokinase, urokinase, tenecteplase or any other agent should not be used in patients with UA and NSTEMI.…”