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.
Highlights
Beta-blockers are the main drug treatment used for patients with acute myocardial infarction (AMI)
American Heart Association (ACCF/AHA) guidelines provide a class I recommendation for oral beta-blockers within the first 24 hours of symptom onset and a class IIa indication for intravenous beta-blockers for patients who are hypertensive or have ongoing ischemia [1,2]
Recent data have called into question the role of beta-blockers in AMI, regarding the type, dosage and duration of treatment for patients whose post-AMI course is without arrhythmia, heart failure or recurrent ischemia
Summary
Beta-blockers are the main drug treatment used for patients with acute myocardial infarction (AMI). All guidelines that support the use of beta-blockers in AMI predate reperfusion and contemporary medical therapy with statins and antiplatelet agents [3]. Recent data have called into question the role of beta-blockers in AMI, regarding the type, dosage and duration of treatment for patients whose post-AMI course is without arrhythmia, heart failure or recurrent ischemia. In the pre-reperfusion era, reductions in mortality have been reported with beta-blocker use, but the role of this treatment in the reperfusion era is not clear. In the reperfusion era, only reductions in myocardial infarction and angina have been observed, whereas increases in heart failure and cardiogenic shock have occurred [3,7,8,9,10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
