Abstract 15293: Does Early Treatment with Oral Beta-blockers Reduce In-hospital Mortality in Patients with Acute Myocardial Infarction Undergoing Primary Angioplasty?
Background: Beta-blockers are currently recommended in the early management of patients with acute myocardial infarction (AMI), however, there are few data in the primary percutaneous coronary intervention (PCI) era. We assessed whether early beta-blocker use (within 24 hours from admission) is beneficial for reducing in-hospital mortality in AMI patients undergoing primary PCI.
Methods: We established a multicenter registry in which 1826 patients with AMI from 27 hospitals in Japan were enrolled between 2008 and 2009. In the present investigation, we analyzed in-hospital clinical outcomes of 1400 patients who underwent primary PCI within 24 hours from admission and survived at least 24 hours from admission. Patients were divided into two groups, group A (those who were treated with oral beta-blockers within 24 hours from admission, n=403) and group B (those without beta-blockers within 24 hours from admission, n=997). We compared in-hospital mortality rates between these groups. A multivariate logistic regression model was constructed to identify independent predictors. Propensity score analyses were performed to minimize any selection bias for initial differences between groups.
Results: No difference was observed in baseline characteristics between group A and B, except age (65.8±12.5 vs. 67.9±12.6, p=0.0038), hypertension (72.0% vs. 58.8%, p<0.0001) and Killip class (≥class 3, 6.4% vs. 9.8%, p=0.0002). In-hospital mortality rate of group A was significantly lower than that of group B (1.0% vs. 5.9%, p<0.0001). Logistic regression analysis identified age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.06, p=0.0366), peak creatine kinase (CK) level (OR 4.3, 95% CI 2.1–9.7/log-increase in peak CK, p=0.0002), Killip class 3 or 4 (OR 15.7, 95% CI 8.4–30.4, p<0.0001), and early beta-blocker use (OR 0.28, 95% CI 0.08–0.73, p=0.0198) as independent predictors of in-hospital mortality. Propensity-adjusted odds ratio of early beta-blocker use for in-hospital mortality was consistent (OR 0.30, 95% CI 0.09–0.75, p=0.0227).
Conclusions: Oral beta-blocker treatment within 24 hours from admission may be beneficial for reducing in-hospital mortality in AMI patients undergoing primary PCI.
- © 2010 by American Heart Association, Inc.