Key result
Beta-blocker therapy linked to ~56% lower one-year mortality in acute coronary syndrome.
Why the study?
The evidence for beta-blocker use after ACS, especially in patients with LV dysfunction, is based on data from the late 1990s and needs reassessment in a contemporary population.
Does beta-blocker use reduce one-year all-cause mortality in a contemporary population of patients with acute coronary syndrome?
Observational (n=1,520)
No
Does beta-blocker use reduce one-year all-cause mortality in a contemporary population of patients with acute coronary syndrome?
Hazard Ratio: 0.44 (95% CI 0.31–0.62)
Absolute Event Rate: 7.5% vs 20.3%
p-value: p=<0.001
In a contemporary ACS cohort, beta-blocker use was associated with a 56% relative risk reduction in one-year mortality, extending benefits to those with normal or mildly reduced ejection fraction.
Associated mortality benefit in contemporary ACS should not change practice; leaves open extension to preserved EF pending RCTs.
INTRODUCTION: The evidence for beta-blocker use in patients after acute coronary syndrome (ACS), particularly in those with left ventricular (LV) dysfunction, dates from the late 1990s. We aimed to assess the role of beta-blockers in a contemporary population of patients with ACS. METHODS: Propensity-score matching (1:2) was performed for the use of beta-blockers in a population of consecutive patients admitted to our department with ACS. After matching, 1520 patients were analyzed. Cox regression analysis was used to assess the impact of beta-blocker use on the primary outcome (one-year all-cause mortality). RESULTS: Patients who did not receive beta-blockers were less aggressively treated with other pharmacological and invasive interventions and had higher one-year mortality (20.3% vs. 7.5%). Beta-blocker use was an independent predictor of mortality, with a significant relative risk reduction of 56%. The other independent predictors were age, diabetes, LV dysfunction, heart rate, systolic blood pressure and creatinine on admission. The impact of beta-blockers was significant for all classes of LV function, including patients with normal or mildly reduced ejection fraction. CONCLUSIONS: In a contemporary ACS population, we confirmed the benefits of beta-blocker use after ACS, including in patients with normal or mildly to moderately impaired LV function.
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Timóteo et al. (2018) conducted an observational in Acute coronary syndrome (n=1,520). Beta-blockers vs. No beta-blockers was evaluated on One-year all-cause mortality (HR 0.44, 95% CI 0.31-0.62, p=<0.001). Beta-blocker therapy significantly reduced one-year all-cause mortality by 56% (HR 0.44) compared to no beta-blockers in patients with acute coronary syndrome.
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