Key result
Chronic beta-blocker therapy is not linked to increased risk of cardiogenic shock in STEMI.
Why the study?
The association between chronic beta-blocker treatment and haemodynamics at admission in STEMI patients treated by primary PCI was not well studied.
Does chronic beta-blocker treatment increase the risk of cardiogenic shock or pre-shock at admission in STEMI patients treated with primary PCI?
Cohort (n=4,907)
Does chronic beta-blocker treatment increase the risk of cardiogenic shock or pre-shock at admission in STEMI patients treated with primary PCI?
Hazard Ratio: 0.97 (95% CI 0.65–1.46)
p-value: p=0.90
Chronic beta-blocker therapy prior to STEMI does not increase the risk of presenting with cardiogenic shock or pre-shock at the time of primary PCI.
Chronic beta-blockers were not linked to higher cardiogenic shock risk at STEMI admission; leaves open continuation decisions pending randomized data.
Background: The association between chronic beta-blocker treatment and haemodynamics at admission in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention is not well studied. We investigated the impact of chronic beta-blocker treatment on the risk of cardiogenic shock and pre-shock at admission in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Methods and results: A total of 4907 patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention were included in the study. A total of 1148 patients (23.3%) were on chronic beta-blocker treatment. Cardiogenic shock was observed in 264 patients (5.3%). Pre-shock was defined as a shock index (the ratio of heart rate and systolic blood pressure) of 0.7 or greater, and was observed in 1022 patients (20.8%). The risk of cardiogenic shock in patients with chronic beta-blocker treatment was not increased (adjusted hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.65–1.46, P=0.90). Chronic beta-blocker treatment was also not associated with an increased risk of pre-shock (adjusted HR 0.86, 95% CI 0.68–1.07, P=0.19). Also after propensity score matched analysis, there was no increased risk of cardiogenic shock or pre-shock in patients with chronic beta-blocker treatment (respectively HR 0.97, 95% CI 0.61–1.51, P=0.88 and HR 0.82, 95% CI 0.65–1.06, P=0.12). Conclusion: In ST-segment elevation myocardial infarction, chronic beta-blocker treatment is not associated with an increased risk of cardiogenic shock or pre-shock.
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Roolvink et al. (2018) conducted a cohort in ST-segment elevation myocardial infarction (n=4,907). Chronic beta-blocker treatment vs. No chronic beta-blocker treatment was evaluated on Cardiogenic shock at admission (HR 0.97, 95% CI 0.65-1.46, p=0.90). Chronic beta-blocker treatment in STEMI patients treated with primary PCI was not associated with an increased risk of cardiogenic shock at admission (adjusted HR 0.97; 95% CI 0.65-1.46; P=0.90).
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