Beta-blocker use after myocardial infarction was associated with lower all-cause mortality in patients with COPD, including those with NSTEMI (HR 0.68; 95% CI 0.65-0.72) and STEMI (HR 0.73).
Cohort (n=96,567)
Yes
Does beta-blocker use reduce all-cause and cardiovascular mortality in patients surviving first-time myocardial infarction with and without COPD?
Beta-blocker therapy after myocardial infarction is associated with a survival benefit even in patients with COPD, regardless of COPD severity, supporting their safety and efficacy in this population.
Hazard Ratio: 0.68 (95% CI 0.65–0.72)
AIMS: To investigate the association of beta-blocker use after first-time myocardial infarction (MI) with all-cause mortality and cardiovascular mortality in patients with and without chronic obstructive pulmonary disease (COPD), and whether it varies by type of MI, and COPD severity, and mMRC dyspnoea burden. METHODS: Danish nationwide cohort study of patients discharged after hospitalisation for MI from 2003-2015 using the National Prescription Registry and other individual level registers. Multivariable Cox regression models with time-dependent variables using continuously updated data on claimed prescriptions on beta-blockers to account for varying use during follow-up. RESULT: Of 96,567 patients surviving MI, 10,884 (11.3%) had COPD. COPD patients had more often non-ST-elevation MI (NSTEMI) compared to non-COPD patients (88.5% vs. 79.5%), and were older (median age 75 vs. 68 years). Presence of COPD was associated with higher all-cause mortality both in STEMI (HR 1.60 95% CI 1.46-1.77) and NSTEMI (HR 1.47 1.43-1.52). For COPD patients, beta-blocker users had lower mortality independently of type of MI (HR 0.73 0.61-0.88 in STEMI and HR 0.68 0.65-0.72 in NSTEMI). Overall, estimates were similar in patients without COPD. Among high-risk COPD patients with severe COPD and frequent exacerbations (5-year mortality 63.5% and 62.6%, respectively) beta-blockers were also associated with lower mortality. Analyses of cardiovascular mortality showed similar results. CONCLUSION: Beta-blocker use was associated with lower risk of mortality following MI independently of type of MI, presence or abscense of COPD, and COPD severity. This supports that beta-blocker treatment carries no increased mortality risk in COPD, regardless of COPD severity and dyspnoea score.
Rasmussen et al. (Wed,) conducted a cohort in Myocardial infarction with and without chronic obstructive pulmonary disease (n=96,567). Beta-blocker use vs. Non-use of beta-blockers was evaluated on All-cause mortality (HR 0.68, 95% CI 0.65-0.72). Beta-blocker use after myocardial infarction was associated with lower all-cause mortality in patients with COPD, including those with NSTEMI (HR 0.68; 95% CI 0.65-0.72) and STEMI (HR 0.73).