Effectiveness of beta-blocker therapy after acute myocardial infarction in elderly patients with chronic obstructive pulmonary disease or asthma
Effectiveness of beta-blocker therapy after acute myocardial infarction in elderly patients with chronic obstructive pulmonary disease or asthma
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DOI：
10.1016/s0735-1097(01)01225-6
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发表时间：
2001-06-01
影响因子：
24
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Chen, J;Radford, MJ;Krumholz, HM
目的 我们评估了患有慢性阻塞性肺疾病 (COPD) 或哮喘的老年患者在急性心肌梗死 (AMI) 后使用 β 受体阻滞剂治疗的使用情况和有效性。 背景 由于患有 COPD 和哮喘的患者大部分被排除在 AMI 的 β 受体阻滞剂治疗临床试验之外，因此这些患者在 AMI 后从 β 受体阻滞剂治疗中受益的程度尚不明确。与无 COPD 或哮喘的患者相比，未使用 β 受体激动剂的 COPD 或哮喘患者、同时使用 β 受体激动剂的 COPD 或哮喘患者以及有严重疾病证据的患者（使用泼尼松或既往因 COPD 或哮喘住院）的 β 受体阻滞剂和一年死亡率。 结果 在 54,962 名没有 β 受体阻滞剂禁忌症的患者中，慢性阻塞性肺病或哮喘患者 (20%) 服用 β 受体阻滞剂的可能性显着降低AMI 后出院时。在调整人口和临床因素后，我们发现，对于未接受β受体激动剂治疗的慢性阻塞性肺病或哮喘患者，β受体阻滞剂与较低的一年死亡率相关（相对风险[RR] = 0.85，95%置信区间[CI] 0.73至1.00），与没有慢性阻塞性肺病或哮喘的患者相似（RR = 0.86，95% CI 0.81至0.92）。在同时使用 β 受体激动剂或患有严重 COPD 或哮喘的患者中，未发现 β 受体阻滞剂具有生存获益。结论 AMI 后的 β 受体阻滞剂治疗可能对患有轻度疾病的 CORD 或哮喘患者有益。对于患有更严重肺部疾病的老年 AMI 患者，没有发现生存获益。 (J Am Coll Cardiol 2001；37:1950-6) (C) 2001 年，美国心脏病学会。
OBJECTIVES We evaluated the use and effectiveness of beta-blocker therapy after acute myocardial infarction (AMI) for elderly patients with chronic obstructive pulmonary disease (COPD) or asthma.BACKGROUND Because patients with COPD and asthma have largely been excluded from clinical trials of beta-blocker therapy for AMI, the extent to which these patients would benefit from beta-blocker therapy after AMI is not well defined.METHODS Using data from the Cooperative Cardiovascular Project, we examined the relationship between discharge use of beta-blockers and one-year mortality in patients with COPD or asthma who were not using beta-agonists, patients with COPD or asthma who were concurrently using beta-agonists and patients with evidence of severe disease (use of prednisone or previous hospitalization for COPD or asthma) compared with patients without COPD or asthma.RESULTS Of 54,962 patients without contraindications to beta-blockers, patients with COPD or asthma (20%) were significantly less likely to be prescribed beta-blockers at discharge after AMI. After adjusting for demographic and clinical factors, we found that beta-blockers were associated with lower one-year mortality in patients with COPD or asthma who were not on beta-agonist therapy (relative risk [RR] = 0.85, 95% confidence interval [CI] 0.73 to 1.00), similar to patients without COPD or asthma (RR = 0.86, 95% CI 0.81 to 0.92). A survival benefit for beta-blockers was not found among patients concurrently using beta-agonists or with severe COPD or asthma.CONCLUSIONS Beta-blocker therapy after AMI may be beneficial for CORD or asthma patients with mild disease. A survival benefit was not found for elderly AMI patients with more severe pulmonary disease. (J Am Coll Cardiol 2001;37:1950-6) (C) 2001 by the American College of Cardiology.