Abstract 12958: Betablocker Use in Patients with Chronic Pulmonary Disease During Acute Phase of Myocardial Infarction. Insights from Euro Heart Survey Acute Coronary Syndromes III

Abstract

Background: Chronic Pulmonary Disease (CPD) is commonly considered as a contra indication for betablocker treatment (BB), even though the risk of ischemic complications and heart failure is greater than the risk of asthmatic complications. Using data from EHS-ASC III, we determined the impact of betablocker use in patients with a history of CPD.

Methods: EHS-ASC III included patients with ACS between 2006 and 2008 from 138 centres in 36 countries. Recorded variables corresponded to the CARDS dataset, including history of CPD. Baseline characteristics, management and in hospital death were compared between groups according to CPD status. Multivariate regression was used to determine the impact on in-hospital death of betablocker use in patients with vs without CPD, adjusted for baseline characteristics and treatments.

Results: Among 16,269 patients, 1279 had a history of CPD and a final diagnosis of acute MI. Patients with CPD were on average 5 years older, had more diabetes, hypertension, previous MI, stroke, heart and renal failure and had a higher GRACE risk score. They less often received aspirin, clopidogrel and BB. In-hospital death was almost twice as high in CPD patients (10.2% vs 5.7%, p<0.0001). Among patients with CPD, 54% received BB, and use of BB was associated with lower mortality (figure). Multivariate analyses showed a 60% higher mortality in CPD patients without BB. The benefit of BB in CPD patients was more pronounced in STEMI.

Conclusions: In EHS-ACS III, lower mortality was observed with BB use in all patients, irrespective of history of CPD. In spite of the lower mortality rates observed in CPD patients treated with BB, nearly half of them did not receive BB therapy during hospitalization. Our results suggest that BB prescription should be tried in all CPD patients.