What question did this study set out to answer?

To evaluate the impact of beta-blocker and angiotensin-converting-enzyme inhibitor dosing on in-hospital and 1-year clinical outcomes following acute ST-elevation myocardial infarction.

January 1, 2015Circulation JournalOpen Access

Relationship Between Beta-Blocker and Angiotensin-Converting Enzyme Inhibitor Dose and Clinical Outcome Following Acute Myocardial Infarction

Q: What are the key findings of this study?

Absence of beta-blocker prescription in the first 24 hours following acute myocardial infarction was independently associated with higher in-hospital mortality (23.4% vs 4.2% for those treated, OR 5.78).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Myocardial Infarction (n=1461). Intervention: Beta-blockers and Angiotensin-converting enzyme inhibitors vs. No treatment. Primary outcome: In-hospital mortality (OR 5.78, 95% CI 2.62-12.76, p=<0.001).

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Key result

Omitting early beta-blockers post-AMI linked to ~478% higher in-hospital mortality.

OR 5.78
95% CI 2.62-12.76
P<0.001
n=1,461

Why the study?

Does the dose of beta-blockers and ACE inhibitors administered following ST-elevation MI improve mortality and clinical outcomes up to 1 year?

Key Points

To evaluate the impact of beta-blocker and angiotensin-converting-enzyme inhibitor dosing on in-hospital and 1-year clinical outcomes following acute ST-elevation myocardial infarction.
Prospective observational cohort study (the RIMA cohort) in France including N=1,461 patients with ST-elevation myocardial infarction.
Prescription doses of beta-blockers and ACE inhibitors were evaluated at 24 hours and at hospital discharge (no treatment, <50% target dose, or ≥50% target dose) with follow-up to 1 year.
Beta-blocker administration within the first 24 hours was associated with significantly lower in-hospital mortality on multivariate analysis (OR 5.78, 95% CI: 2.62–12.76, P<0.001 for non-use).
At 1 year, discharge prescription of higher doses of ACE inhibitors was associated with significantly reduced cardiovascular mortality, heart failure readmissions, and composite events (HR 2.65, 95% CI: 1.32–5.31, P=0.006 for absence of ACE inhibitors at discharge).

Study Design

Type

Cohort (n=1,461)

Multicenter

Yes

Structured PICO

Does the dose of beta-blockers and ACE inhibitors administered following ST-elevation MI improve mortality and clinical outcomes up to 1 year?

Population

1,461 patients with ST-elevation myocardial infarction from the French prospective observational cohort 'RIMA'

Intervention

Beta-blockers and ACE inhibitors administered at 24 hours and at discharge, categorized by dose (<50% of target dose or ≥50% of target dose)

Comparator

No treatment or lower doses (<50% of target dose)

Outcome

In-hospital mortality and 1-year outcomes including cardiovascular mortality, readmission for heart failure, and the composite of cardiovascular mortality and readmission for heart failurehard clinical

Main Result

Effect estimate: OR 5.78 (95% CI 2.62-12.76)

Absolute Event Rate: 4.2% vs 23.4%

p-value: p=<0.001

Early beta-blocker administration is associated with reduced in-hospital mortality, while higher discharge doses of ACE inhibitors are associated with improved 1-year outcomes following ST-elevation myocardial infarction.

Limitations

Observational registry subject to considerable confounding factors
Absence of monitoring of the prescription and of uptitration of BB or ACEI during follow-up
Regionwide registry conducted in a rural area, potentially indicating a selection bias
Reasons for the absence of uptitration are uncertain
Requires confirmation in further large-scale clinical studies

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Early beta-blocker use may link to lower in-hospital AMI mortality; leaves open optimal dosing and randomized confirmation.

Cite This Study

Grall et al. (2015) conducted a cohort in Acute Myocardial Infarction (n=1,461). Beta-blockers and Angiotensin-converting enzyme inhibitors vs. No treatment was evaluated on In-hospital mortality (OR 5.78, 95% CI 2.62-12.76, p=<0.001). Absence of beta-blocker prescription in the first 24 hours following acute myocardial infarction was independently associated with higher in-hospital mortality (23.4% vs 4.2% for those treated, OR 5.78).

synapsesocial.com/papers/6a0895fbad370a6b44de340f https://doi.org/10.1253/circj.cj-14-0633

Topics

Heart failure HFrEF treatment

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Relationship Between Beta-Blocker and Angiotensin-Converting Enzyme Inhibitor Dose and Clinical Outcome Following Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Relationship Between Beta-Blocker and Angiotensin-Converting Enzyme Inhibitor Dose and Clinical Outcome Following Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

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