Document Detail


Does beta-blocker therapy improve clinical outcomes of acute myocardial infarction after successful primary angioplasty?
MedLine Citation:
PMID:  15145098     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to determine if beta-blocker therapy improves clinical outcomes of acute myocardial infarction (AMI) after successful primary percutaneous coronary intervention (PCI). BACKGROUND: We have shown that pre-treatment with beta-blockers has a beneficial effect on short-term clinical outcomes in patients undergoing primary PCI for AMI. It is unknown if beta-blocker therapy after successful primary PCI improves prognosis of AMI. METHODS: We analyzed clinical, angiographic, and outcomes data in 2442 patients who underwent successful primary PCI in the Primary Angioplasty in Acute Myocardial Infarction-2 (PAMI-2), PAMI No Surgery-on-Site (PAMI noSOS), Stent PAMI, and Air PAMI trials. We classified patients into beta group (those who received beta-blockers after successful PCI, n = 1661) and no-beta group (n = 781). We compared death and major adverse cardiac events (MACE) (death, reinfarction, and ischemia-driven target vessel revascularization) at six months between groups receiving and not receiving beta-blockers. RESULTS: At six months, beta patients were less likely to die (2.2% vs. 6.6%, p < 0.0001) or experience MACE (14 vs. 17%, p = 0.036). In multivariate analysis, beta-blockers were independently associated with lower six-month mortality (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.26 to 0.73, p = 0.0016). Beta-blocker therapy was an independent predictor of lower six-month events in high-risk subgroups: ejection fraction <or=50% (death: OR 0.34, 95% CI 0.19 to 0.60, p = 0.0002) or multi-vessel coronary artery disease (CAD) (death: OR 0.26, 95% CI 0.14 to 0.48, p < 0.0001; MACE: OR 0.57, 95% CI 0.41 to 0.80, p = 0.0011). CONCLUSIONS: Treatment with beta-blockers after successful primary PCI is associated with reduced six-month mortality, with the greatest benefit in patients with a low ejection fraction or multi-vessel CAD.
Authors:
Steven J Kernis; Kishore J Harjai; Gregg W Stone; Lorelei L Grines; Judith A Boura; William W O'Neill; Cindy L Grines
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  43     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-05-17     Completed Date:  2004-06-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1773-9     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Division, William Beaumont Hospital, Royal Oak, Michigan 48331, USA. skernis@beaumont.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use*
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Chemotherapy, Adjuvant
Female
Humans
Male
Middle Aged
Myocardial Infarction / drug therapy*,  mortality,  therapy
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2004 May 19;43(10):1788-90   [PMID:  15145100 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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