Utility of beta-blockade treatment for older postinfarction patients.
Utility of beta-blockade treatment for older postinfarction patients.
复制标题
β-阻断治疗对老年梗塞后患者的效用。
DOI：
10.1111/j.1532-5415.1995.tb07044.x
复制
发表时间：
1995
影响因子：
6.3
通讯作者：
Wei,JY
中科院分区：
文献类型：
--
作者：
Park,KC;Forman,DE;Wei,JY
目的：老年人心肌梗死（MI）的患病率很高。虽然已知MI后使用β受体阻滞剂可降低年轻成人的MI死亡率，但其对75岁以上成人的疗效仍不清楚。我们假设老年人心肌梗死后使用β受体阻滞剂可以改善临床结局。设计：回顾性队列研究。背景：一家以社区为基础的三级医疗教学医院。方法：1988年1月至1989年9月期间，共有1011例年龄在60至89岁之间的连续心肌梗死患者入住波士顿贝斯以色列医院，并进行了本研究的筛选。118例患者符合资格标准，其中76例在心肌梗死后至少5天接受美托洛尔≥25 mg/天。42名年龄和临床匹配的患者同样适合β受体阻滞剂治疗，但他们的医生在住院期间和住院后忽略了这一治疗。结果：年龄60 ~ 89岁的MI患者接受美托洛尔治疗后，年龄调整后死亡率降低76%（RR 0.24;P<0.001; 95%CI 0.11-0.54）。多变量logistic回归分析显示，老年MI患者的死亡率降低12%（95%CI 0.75-1.00），归因于美托洛尔治疗。接受美托洛尔治疗的患者再梗死率没有变化，随后再住院率显着增加之间的美托洛尔patients.CONCLUSIONS：使用美托洛尔显着降低老年MI患者的死亡率。美托洛尔治疗患者的再梗死或再住院率均未降低，这一事实可能与本研究的方法学局限性有关。死亡率数据支持老年患者受益于梗死后β受体阻滞剂的假设。
OBJECTIVE:The prevalence of myocardial infarction (MI) in older people is high. Whereas use of beta‐blockers after MI is known to lower MI mortality in younger adults, its efficacy for adults more than 75 years of age remains less clear. We hypothesized that use of beta‐blockers after MI in older adults would improve clinical outcomes.DESIGN:Retrospective cohort study.SETTING:A community‐based, tertiary‐care teaching hospital.METHODS:A total of 1011 consecutive MI patients aged 60 to 89 were admitted to Boston's Beth Israel Hospital between January 1988 and September 1989 and were screened for this study. One hundred eighteen patients met eligibility criteria, of whom 76 received metoprolol, ≥25 mg/day for at least 5 days after their MI. Forty‐two age and clinically matched patients were similarly suitable for beta‐blocker therapy, but it was omitted by their physicians during and after hospitalization. The latter group served as controls.MEASUREMENTS:Mortality, reinfarction, and subsequent hospital admissions were measured.RESULTS:MI patients aged 60 to 89 years who were treated with metoprolol had an age‐adjusted mortality reduction of 76% (RR 0.24;P< .001; 95% CI 0.11–0.54). Multivariate logistic regression analysis showed a 12% mortality reduction (95% CI 0.75–1.00) among older MI patients, attributable to metoprolol therapy. Reinfarction rates were unchanged in patients receiving metoprolol therapy, and subsequent rehospitalizations were significantly increased among the metoprolol patients.CONCLUSIONS:Use of metoprolol significantly reduced mortality in older MI patients. The fact that metoprolol‐treated patients had neither reduced reinfarctions or rehospitalizations may relate to methologic limitations of this study. The mortality data support the hypothesis that older patients benefit from postinfarction beta‐blockade.