Short-term/long-term prognosis with or without beta-blockers in patients without heart failure and with preserved ejection fraction after acute myocardial infarction: a multicenter retrospective cohort study.
Short-term/long-term prognosis with or without beta-blockers in patients without heart failure and with preserved ejection fraction after acute myocardial infarction: a multicenter retrospective cohort study.
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DOI：
10.1186/s12872-022-02631-8
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发表时间：
2022-04-26
影响因子：
2.1
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-受体阻滞剂在无心力衰竭且左心室射血分数（LVEF≥50%）保留的急性心肌梗死患者中的作用尚不清楚。我们的研究旨在回顾性分析β受体阻滞剂对这类患者的相关性。这是一项多中心回顾性研究。在筛选5332例急性心肌梗死患者后，共纳入2519例无心力衰竭且LVEF≥50%的患者。患者被分为两组：处方（n = 2049）和非处方（n = 470）受体阻滞剂组。采用倾向得分反概率处理加权法控制混杂因素。我们分析了-受体阻滞剂与短期（1年）和长期（中位，3.61年）预后之间的关系。主要结局为全因死亡率。次要结局为全因再住院、心源性死亡、复发性心肌梗死、新发心力衰竭再住院。该研究显示，在短期内，β受体阻滞剂出院与全因死亡率之间没有统计学上的显著关联[经IPTW校正，HR 1.02；95%可信区间0.43 - -2.40;P = 0.966]或长期[IPTW调整后，HR 1.17；95%可信区间0.70 - -1.94;p = 0.547]。使用受体阻滞剂出院与短期心肌梗死复发风险降低显著相关[IPTW调整后，HR 0.44；95%可信区间0.20 - -0.97;P = 0.043]，但无长期关系[IPTW调整后，HR 1.11；95%可信区间0.61 - -2.03;p = 0.735]。其他结果，如新发心力衰竭再住院和全因再住院，在短期或长期均未观察到有意义的差异。敏感性分析结果与此一致。在短期内，β受体阻滞剂可能与无心力衰竭且急性心肌梗死后左心室射血分数保留的患者心肌梗死复发风险降低有关。β受体阻滞剂可能与这些患者的全因死亡率无关，无论是短期还是长期。β受体阻滞剂对急性心肌梗死合并射血分数正常患者预后的影响，NCT04485988，注册日期：2020年7月24日。回顾注册。在线版本包含补充材料，可在10.1186/s12872-022-02631-8获得。
The role of beta-blockers in acute myocardial infarction patients without heart failure and with preserved left ventricular ejection fraction (LVEF ≥ 50%) is unknown. Our study aimed to retrospectively analyze the associations of beta-blockers on such patients. This is a multicenter, retrospective study. After screening 5,332 acute myocardial infarction patients, a total of 2519 patients without heart failure and with LVEF ≥ 50% were included. The patients were divided into two groups: the prescribed (n = 2049) and unprescribed (n = 470) beta-blockers group. The propensity score inverse probability treatment weighting was used to control confounding factors. We analyzed the associations between beta-blockers and outcomes in the short-term (1-year) and long-term (median, 3.61 years). The primary outcome was all-cause mortality. The secondary outcomes were all-cause rehospitalization, cardiac death, recurrent myocardial infarction, new-onset heart failure rehospitalization. This study shows no statistically significant association between discharged with beta-blockers and all-cause mortality, either in the short-term [IPTW Adjusted, HR 1.02; 95%CI 0.43–2.40; P = 0.966] or long-term [IPTW Adjusted, HR 1.17; 95%CI 0.70–1.94; P = 0.547]. Discharged with beta-blockers was significantly associated with a reduced risk of short-term recurrent myocardial infarction [IPTW Adjusted, HR 0.44; 95%CI 0.20–0.97; P = 0.043], but there was no long-term relationship [IPTW Adjusted, HR 1.11; 95%CI 0.61–2.03; P = 0.735]. Other outcomes, such as new-onset heart failure rehospitalization and all-cause rehospitalization, were not observed with meaningful differences in either the short- or long-term. The results of sensitivity analysis were consistent with this. Beta-blockers might be associated with a reduced risk of recurrent myocardial infarction in patients without heart failure and with preserved left ventricular ejection fraction after acute myocardial infarction, in the short term. Beta-blockers might not be related to all-cause mortality in those patients, either in the short-term or long-term. Clinical trial registration Influence of Beta-blockers on Prognosis in Patients with Acute Myocardial Infarction Complicated with Normal Ejection Fraction, NCT04485988, Registered on 24/07/2020. Retrospectively registered. The online version contains supplementary material available at 10.1186/s12872-022-02631-8.