Abstract 11992: Immediate Beta-blocker Therapy Reduces Mortality of Patients With St-segment Elevation Myocardial Infarction
Background: Despite the recommendations to initiate β-blockade to all patients with an ST-segment elevation myocardial infarction (STEMI), data concerning the timing of the administration of β-blockers are controversially discussed.
Methods: In view of these controversies we analyzed the effect of immediate versus delayed β-blockade on all cause mortality of patients with STEMI in the Lower Austrian Myocardial Infarction Network. The data of all patients with STEMI defined according to the AHA-criteria and treated according to the treatment protocol of the network were consecutively collected. The treatment protocol recommended either the immediate oral administration of 2.5 mg bisoprolol (within 30 minutes after the first ECG) or 24 hours after acute myocardial infarction (delayed β-blockade).
Results: In total, out of the 664 patients with STEMI 343 (n=52%) received immediate β-blockade and 321 (48%) received delayed β-blockade. The all-cause mortality was 18% in the delayed treatment group and 7% in the immediate treatment group (p<0.001; Figure 1). Overall 1-year cardiovascular mortality was 10.4% and was significantly lower in patients with immediate β-blockade compared to delayed β-blockade (1-year mortality: 4.1% versus 17.2%, p<0.001). Multivariate regression analysis identified immediate β-blocker therapy as one of the factors, which has been independently protective against death of any cause (Table 1).
Conclusion: Immediate β-blocker administration in the emergency setting is associated with a reduction of all-cause and cardiovascular mortality in patients with STEMI and seems to be superior to a delayed β-blockade in these patients.
- © 2012 by American Heart Association, Inc.