Abstract 17716: Pre-Procedural Beta Blockade is Associated with Reduced Inpatient Mortality Following Primary PCI: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)

Abstract

Introduction: Early use of beta-adrenergic blockade in acute myocardial infarction (AMI) remains the subject of controversy, with some studies showing benefit and others demonstrating harm. There is a paucity of data on the clinical impact of pre-PCI BB use in patients undergoing primary PCI for ST-elevation myocardial infarction (STEMI).

Methods: We assessed the association between pre-PCI BB and in-hospital outcome among consecutive patients undergoing primary PCI for STEMI from 2008 to 2009 who were enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Pre-PCI BB use was defined as any BB given prior to presentation to the cath lab (home, ED, ACS protocol, IV or PO). Inverse propensity score weighting was used to account for the non-randomized use of pre-PCI BBs.

Results: Our study cohort comprised of 7,667 patients undergoing primary PCI for STEMI during the study period, with 4,769 (62.2%) receiving pre-PCI BB. Patients receiving pre-PCI BB were older and had higher rates of diabetes, HTN, and prior MI, PCI or CABG. In propensity-matched, risk-adjusted models pre-PCI BB use was associated with lower rates of intraprocedural VT/VF requiring therapy (OR 0.58, CI 0.44-0.76, p<0.0001) and lower in-hospital mortality (OR 0.65, CI 0.45-0.94, p=0.0218). Rates of cardiogenic shock were not significantly different between the cohorts (Figure 1).

Conclusions: We found that pre-PCI BB use was associated with less intraprocedural VT/VF and lower in-hospital mortality without any increase in the incidence of cardiogenic shock. Our study may suggest a beneficial role for pre-PCI BB in STEMI.