Abstract
Background. Benefits of beta-adrenergic receptor blockers (BB) following ST-elevation myocardial infarction (STEMI) are based on data before primary percutaneous coronary intervention (PCI) became the therapeutic first choice. This study examined the relationship between BB dose and magnitude of left ventricular ejection fraction (LVEF) improvement in STEMI following primary PCI. Methods and Findings. A total of 235 STEMI patients following primary PCI who underwent echocardiography during the acute phase and over 6 months from onset were studied retrospectively. Serial LVEFs were assessed for three groups: no BB (n=33), carvedilol (n=163), and bisoprolol (n=42). Left ventricular reverse remodeling (RR) was defined as LVEF improvement ≥10%. All patients received fixed doses of BB and renin-angiotensin system inhibitor during observation. The median interval between echocardiographs was 526 days. The mean LVEF change was +2.6% (acute: 53.9±9.9%, chronic: 56.4±10.6%). Carvedilol and bisoprolol groups showed LVEF improvement, but none was seen in the no BB group (+3.7±6.5%, +3.8±6.9%, -4.2±5.0%, P<0.0001, respectively). The LVEF improvement effect was BB dose dependent. Therapy with BBs had a high rate of RR (no BB 0%, carvedilol 19.4%, bisoprolol 16.7%, P=0.0225, respectively). Multivariate analysis showed the following predictors of RR: baseline LVEF <50% and regular dose of BB, ≥10 mg of carvedilol or ≥1.25 mg of bisoprolol (Odds ratio 2.35, 95% Confidence Interval [CI] 1.12-5.02, P=0.0242; Odds ratio 4.45, 95% CI 2.06-10.27, P=0.0001). Conclusions. Immediate BB administration following primary PCI for STEMI provided a dose-dependent LVEF improvement. A LVEF <50% and regular dose of BB are predictors of RR.
Highlights
Various large clinical trials confirmed that reninangiotensin system inhibitors or beta-adrenergic blockers (BB) have a preventive effect in left ventricular remodeling and improvement in long-term survival. [1,2,3,4,5,6,7,8] Left ventricular reverse remodeling (RR) produced by these optimal medical therapy was recognized as an important surrogate marker toward improvement of clinical outcomes
To study the relationship between dosage of beta-adrenergic receptor blockers (BB) and the magnitude of left ventricular ejection fraction (LVEF) improvement in ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI), our study examined the serial echocardiographic evaluations at acute and chronic phase
This study revealed the relationship between BB dose and the magnitude of LVEF improvement in STEMI following primary PCI using serial echocardiography assessment
Summary
Various large clinical trials confirmed that reninangiotensin system inhibitors or beta-adrenergic blockers (BB) have a preventive effect in left ventricular remodeling and improvement in long-term survival. [1,2,3,4,5,6,7,8] Left ventricular reverse remodeling (RR) produced by these optimal medical therapy was recognized as an important surrogate marker toward improvement of clinical outcomes. [9, 10] these guidelines are mainly based on data before primary percutaneous coronary intervention (PCI) became the first choice for revascularization Recent studies, such as the OACIS trial and posthoc sub-analysis of the J-Cypher registry, proved that BB did not always contribute to the improvement of long-term outcomes in STEMI. [9, 11] The beneficial effects seen in those studies were limited in patients with higher risk or low left ventricular ejection fraction (LVEF) These studies suggested potential room for revision regarding BB dose or indication for STEMI in the current era, when prompt revascularization by primary PCI is a standard therapy. Benefits of beta-adrenergic receptor blockers (BB) following ST-elevation myocardial infarction (STEMI) are based on data before primary percutaneous coronary intervention (PCI) became the therapeutic first choice.
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