What is the clinical evidence from this study?

Study design: Observational. Population: ST-elevation myocardial infarction (STEMI) with cardiogenic shock (n=744). Intervention: In-hospital oral beta-blockers vs. No in-hospital oral beta-blockers. Primary outcome: 2-year all-cause death (HR 1.29, 95% CI 0.95-1.75, p=0.099).

What does this research mean for the field?

In-hospital initiation of oral beta-blockers does not improve long-term all-cause mortality in STEMI patients with cardiogenic shock, and may trend toward increased mortality, particularly in hospitals with less experience in treating cardiogenic shock. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 13, 2025Frontiers in Medicine2 citationsOpen Access

Impact of in-hospital oral beta-blockers initiation on long-term outcomes in ST-elevation myocardial infarction patients with cardiogenic shock

XGXiaojin GaoInterventional / Structural Cardiology MLMengyuan LiuTianjin University JXJing XuShandong University of Technology

Key Result

In-hospital initiation of oral beta-blockers showed no significant benefit on 2-year all-cause mortality in STEMI patients with cardiogenic shock (HR 1.29), with a trend toward increased mortality.

Study Design

Type

Observational (n=744)

Multicenter

Yes

Structured PICO

Does in-hospital oral beta-blockers initiation reduce all-cause death in STEMI patients with cardiogenic shock?

Population

744 STEMI patients who presented with cardiogenic shock (CS) at admission, from the CAMI registry in mainland China

Intervention

In-hospital initiation of oral beta-blockers

Comparator

No in-hospital oral beta-blockers

Outcome

All-cause death at 2 yearshard clinical

In-hospital initiation of oral beta-blockers in STEMI patients with cardiogenic shock does not improve long-term survival and may be associated with increased mortality, particularly in less experienced centers.

Main Result

Effect estimate: HR 1.29 (95% CI 0.95-1.75)

Absolute Event Rate: 24.2% vs 54.8%

p-value: p=0.099

Limitations

Observational study design with potential unmeasured confounders
Absence of systematic hemodynamic monitoring precluded the use of more refined shock classification systems
All included patients were Chinese, limiting extrapolation to other ethnic groups
Exact timing of in-hospital beta-blocker initiation for each patient was not accurately documented
Doses, titration strategies, and types of in-hospital oral beta-blockers, as well as patients' long-term adherence were not specifically documented

Abstract

Background: Early revascularization enables ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock (CS) to initiate oral beta-blockers once hemodynamic stability is achieved, but the impact of such initiation on prognosis remains unknown. We aimed to describe the clinical use of oral beta-blockers and assess its impact on long-term outcomes in STEMI patients with CS in a real-world setting. Materials and methods: The China Acute Myocardial Infarction registry (CAMI) is a prospective observational study that enrolls patients with acute myocardial infarction from three-level hospitals across 31 administrative regions in mainland China. Among 19,112 STEMI patients in the CAMI registry, a total of 744 STEMI patients who presented with CS at admission were analyzed. Multivariate regression models were used to evaluate the impact of in-hospital oral beta-blockers on 2-year outcomes. Inverse probability treatment weighting (IPTW) score was further used to address biases between the groups with and without oral beta-blockers. The primary endpoint was all-cause death. Results: = 0.002). Conclusion: No benefit of in-hospital oral beta-blockers initiation on long-term all-cause mortality was found in Chinese STEMI patients with CS, and a trend toward increased mortality existed, especially in small-scale hospitals with insufficient experience in CS treatment.

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