Association of beta-blocker treatment with mortality following myocardial infarction in patients with chronic obstructive pulmonary disease and heart failure or left ventricular dysfunction: a propensity matched-cohort analysis from the High-Risk Myocardial Infarction Database Initiative
Association of beta-blocker treatment with mortality following myocardial infarction in patients with chronic obstructive pulmonary disease and heart failure or left ventricular dysfunction: a propensity matched-cohort analysis from the High-Risk Myocardial Infarction Database Initiative
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DOI：
10.1002/ejhf.647
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发表时间：
2017-02-01
影响因子：
18.2
通讯作者：
Zannad, Faiez
中科院分区：
文献类型：
--
作者：
Coiro, Stefano;Girerd, Nicolas;Zannad, Faiez
目的 确定基线 β 受体阻滞剂使用对合并心力衰竭 (HF) 或左心室功能障碍以及有慢性阻塞性肺疾病 (COPD) 病史的心肌梗死 (MI) 幸存者长期预后的影响。 方法和结果 在高风险 MI 数据库计划的 28 771 名患者中，我们确定了 1573 名有 COPD 基线病史的患者。我们评估了基线时使用 β 受体阻滞剂（822 例使用 β 受体阻滞剂，751 例不使用 β 受体阻滞剂）与全因死亡率和心血管死亡率之间的关联。在单变量 Cox 分析中，发现β受体阻滞剂的使用与较低的全因死亡率[风险比 (HR)= 0.61，95% 置信区间 (CI) 0.51-0.75，P < 0.0001] 和心血管死亡率（HR= 0.63，95% CI 0.51-0.78，P < 0.0001）相关。对混杂因素（包括 24 个基线协变量）进行广泛调整后，COPD 患者仍然受益于 β 受体阻滞剂的使用（全因死亡率 HR= 0.73，95% CI 0.60-0.90，P = 0.002；心血管死亡率 HR= 0.77，95% CI 0.61-0.97，P = 0.025）。对根据上述 24 个基线特征构建的倾向得分 (PS) 进行调整后，得到了类似的结果。在使用 1:1 最近邻匹配法对 PS 进行匹配的 561 对服用或未服用 β 受体阻滞剂的患者组成的队列中，接受 β 受体阻滞剂治疗的患者的全因死亡（HR= 0.71，95% CI 0.56-0.89，P = 0.003）和心血管死亡（HR= 0.76，95% CI 0.59-0.97，P = 0.003）较少。 0.032）。结论在经过良好治疗的高危心肌梗死幸存者队列的特定环境中，β-受体阻滞剂与 COPD 患者的更好预后相关。
Aims To determine the influence of baseline beta-blocker use on long-term prognosis ofmyocardial infarction (MI) survivors complicated with heart failure (HF) or with left ventricular dysfunction and with history of chronic obstructive pulmonary disease (COPD).Methods and results Among the 28 771 patients from the High-Risk MI Database Initiative we identified 1573 patients with a baseline history of COPD. We evaluated the association between beta-blocker use at baseline (822 with beta-blocker and 751 without) on the rates of all-cause and cardiovascular mortality. On univariable Cox analysis, beta-blocker use was found to be associated with lower rates of both all-cause [ hazard ratio (HR)= 0.61, 95% confidence interval (CI) 0.51-0.75, P < 0.0001] and cardiovascular mortality (HR= 0.63, 95% CI 0.51-0.78, P < 0.0001). After extensive adjustment for confounding, including 24 baseline covariates, COPD patients still benefited from beta-blocker usage (HR= 0.73, 95% CI 0.60-0.90, P = 0.002 for all-cause mortality; HR= 0.77, 95% CI 0.61-0.97, P = 0.025 for cardiovascular mortality). Adjusting for propensity scores (PS) constructed from the 24 aforementioned baseline characteristics provided similar results. In a cohort of 561 pairs of patients taking or not taking beta-blocker matched on PS using a 1: 1 nearest-neighbour matching method, patients treated with beta-blocker experienced fewer all-cause deaths (HR= 0.71,95% CI 0.56-0.89, P = 0.003) and cardiovascular deaths (HR= 0.76, 95% CI 0.59-0.97, P = 0.032).Conclusions In the specific setting of a well-treated cohort of high-risk MI survivors, beta-blockers were associated with better outcomes in patients with COPD.