What is the clinical evidence from this study?

Study design: Cohort. Population: Post-myocardial infarct with preserved left ventricular systolic function (n=208). Intervention: Beta-blocker therapy vs. No beta-blocker therapy. Primary outcome: Overall mortality (HR 2.5, 95% CI 1.25-6.42, p=0.01).

What question did this study set out to answer?

Evaluate the impact of long-term beta-blocker therapy on survival and clinical outcomes in post-myocardial infarction patients who maintain preserved left ventricular systolic function.

February 1, 2010Pacing and Clinical Electrophysiology

β-Blocker in Post-Myocardial Infarct Survivors with Preserved Left Ventricular Systolic Function

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Key result

Long-term beta-blocker use in post-MI patients with preserved LV function was associated with decreased overall mortality compared to no beta-blocker (9% vs 26%; HR 2.5 for no beta-blocker, P=0.01).

Why the study?

Does long-term beta-blocker therapy reduce mortality in post-myocardial infarct patients with preserved left ventricular systolic function?

Population

208 post-myocardial infarct patients referred for a cardiac rehabilitation program with preserved left…

Comparison

Long-term beta-blocker therapy vs No beta-blocker therapy

Design

Cohort

Follow-up

mean 58.5 +/- 2.7 months

Authors

CSChung‐Wah SiuElectrophysiology VPVincent PongChinese University of Hong Kong MJMan‐Hong JimGrantham Hospital

Discussion

Member takes

Implication

Should not change practice in post-MI preserved LVEF; hypothesis-generating observational data require RCT confirmation.

Key Points

Evaluate the impact of long-term beta-blocker therapy on survival and clinical outcomes in post-myocardial infarction patients who maintain preserved left ventricular systolic function.
Studied N=208 post-myocardial infarction patients referred to cardiac rehabilitation who exhibited preserved left ventricular function (ejection fraction >= 50%), negative exercise stress testing, and ongoing ACE inhibitor therapy.
Evaluated clinical outcomes comparing patients taking beta-blockers (n=154) versus those not taking beta-blockers (n=54) across a mean follow-up of 58.5 +/- 2.7 months.
All-cause mortality occurred in 9% (14/154) of beta-blocker users compared to 26% (14/54) of non-users (HR: 2.5, 95% CI: 1.25-6.42, P = 0.01).
Patients without beta-blockers experienced higher cardiac death (HR: 3.0, 95% CI: 1.07-12.10, P = 0.04) and non-sudden cardiac death (HR: 10.1, 95% CI: 1.82-89.65, P = 0.01), but not sudden cardiac death (HR: 1.6, 95% CI: 0.34-7.61, P = 0.54).
Multivariate Cox regression identified lack of beta-blocker therapy (HR: 2.41, 95% CI: 1.14-5.09, P = 0.02) and age >= 75 years (HR: 2.55, 95% CI: 1.18-5.49, P = 0.02) as independent predictors of mortality.

Study Design

Type

Cohort (n=208)

Structured PICO

Does long-term beta-blocker therapy reduce mortality in post-myocardial infarct patients with preserved left ventricular systolic function?

Population

208 post-myocardial infarct patients referred for a cardiac rehabilitation program with preserved left ventricular function (ejection fraction >= 50%), negative exercise stress test, and on angiotensin-converting enzyme inhibition. Mean age 62.7 +/- 0.8 years, 76% male.

Intervention

Long-term beta-blocker therapy

Comparator

No beta-blocker therapy

Outcome

Overall mortalityhard clinical

Main Result

Effect estimate: HR 2.5 (95% CI 1.25-6.42)

Absolute Event Rate: 9% vs 26%

p-value: p=0.01

Long-term beta-blocker therapy is associated with reduced overall and cardiac mortality in post-myocardial infarction patients with preserved ejection fraction.

Cite This Study

Siu et al. (2010) conducted a cohort in Post-myocardial infarct with preserved left ventricular systolic function (n=208). Beta-blocker therapy vs. No beta-blocker therapy was evaluated on Overall mortality (HR 2.5, 95% CI 1.25-6.42, p=0.01). Long-term beta-blocker use in post-MI patients with preserved LV function was associated with decreased overall mortality compared to no beta-blocker (9% vs 26%; HR 2.5 for no beta-blocker, P=0.01).

synapsesocial.com/papers/6a11cc8d37ecc83ca3fd4077 https://doi.org/10.1111/j.1540-8159.2010.02694.x

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β-Blocker in Post-Myocardial Infarct Survivors with Preserved Left Ventricular Systolic Function

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

β-Blocker in Post-Myocardial Infarct Survivors with Preserved Left Ventricular Systolic Function

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider