(Circulation. 2000;102:166.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Cardioprotective Effect of Prior ß-Blocker Therapy in Reducing Creatine Kinase-MB Elevation After Coronary Intervention
Benefit Is Extended to Improvement in Intermediate-Term Survival
Presented in part at the 48th Annual Scientific Sessions of the American College of Cardiology, New Orleans, La, March 1999.
From the Cardiac Catheterization Laboratory of the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY.
Correspondence to Samin K. Sharma, MD, Mount Sinai Hospital, Box 1030, One Gustave Levy Place, New York, NY 10029-6574. E-mail: samin_sharma{at}smtplink.mssm.edu
Background—Both retrospective
studies and prospective randomized trials have shown that ß-blockers
improve survival and reduce the risk of reinfarction in patients with
myocardial infarction. To evaluate whether ß-blockers exert similar
protective benefits during and after coronary intervention, we
studied the incidence of postprocedure creatine kinase (CK)-MB
elevation in patients with or without prior ß-blocker therapy and its
effect on intermediate-term (
1 year) survival.
Methods and Results—We prospectively analyzed 1675 consecutive patients undergoing coronary intervention; of these patients, 643 (38.4%) were on ß-blocker therapy before the intervention. The incidence of CK-MB elevation after coronary intervention was 13.2% in patients on ß-blocker therapy before intervention and 22.1% in patients who were not on ß-blockers (P<0.001). Patients with prior ß-blocker therapy had lower persistent/recurrent postprocedure chest pain and lower preprocedure and postprocedure heart rates and mean blood pressures compared with patients who were not on ß-blockers (P<0.001). Multiple linear regression analysis revealed prior ß-blocker therapy as the sole independent factor for lower CK-MB release after coronary intervention. During intermediate-term follow-up at 15±3 months, patients on ß-blocker therapy before intervention had lower mortality rates compared with those not on ß-blockers (0.78% versus 1.96%; P=0.04), although the benefit was independent of the reduction in CK-MB release.
Conclusions—Our nonrandomized, prospective analysis suggests that prior ß-blocker therapy has a cardioprotective effect in limiting CK-MB release after coronary intervention and that it is associated with a lower mortality at intermediate-term follow-up.
Key Words: creatine kinase • ß-blocker • angioplasty • myocardial infarction • prognosis
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