Effect of Beta-Blocker Dose on Survival After Acute Myocardial Infarction.
Effect of Beta-Blocker Dose on Survival After Acute Myocardial Infarction.
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DOI：
10.1016/j.jacc.2015.07.047
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发表时间：
2015-09-29
影响因子：
24
通讯作者：
OBTAIN Investigators
中科院分区：
文献类型：
--
作者：
Goldberger JJ;Bonow RO;Cuffe M;Liu L;Rosenberg Y;Shah PK;Smith SC Jr;Subačius H;OBTAIN Investigators
Beta-blocker therapy after acute myocardial infarction (MI) improves survival. Beta-blocker doses used in clinical practice are often substantially lower than those used in the randomized trials establishing their efficacy. This study evaluated the association of beta-blocker dose with survival after acute MI, hypothesizing that higher dose beta-blocker therapy will be associated with increased survival. A multicenter registry enrolled 7,057 consecutive patients with acute MI. Discharge beta-blocker dose was indexed to the target beta-blocker doses used in randomized clinical trials, grouped as >0% to 12.5%, >12.5% to 25%, >25% to 50%, and >50% of target dose. Follow-up vital status was assessed, with the primary endpoint of time-to-death right-censored at 2 years. Multivariable and propensity score analyses were used to account for group differences. Of 6,682 with follow-up (median 2.1 years), 91.5% were discharged on beta-blocker (mean dose 38.1%). Lower mortality was observed with all beta-blocker doses (p < 0.0002) versus no beta-blocker therapy. After multivariable adjustment, hazard ratios (HRs) for 2-year mortality compared with the >50% dose were 0.862 (95% confidence interval [CI]: 0.677 to 1.098), 0.799 (95% CI: 0.635 to 1.005), and 0.963 (95% CI: 0.765 to 1.213) for the >0% to 12.5%, >12.5% to 25%, and >25% to 50% of target dose, respectively. Multivariable analysis with an extended set of covariates and propensity score analysis also demonstrated that higher doses were not associated with better outcome. These data do not demonstrate increased survival in patients treated with beta-blocker doses approximating those used in prior randomized clinical trials compared with lower doses. These findings provide the rationale to re-engage in research to establish appropriate beta-blocker dosing following MI to derive optimal benefit from this therapy. (The PACE-MI Registry Study - Outcomes of Beta-blocker Therapy After Myocardial Infarction [OBTAIN]: NCT00430612)
