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Intravenous beta-blocker therapy in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention is not associated with benefit regarding short-term mortality : A Swedish nationwide observational study

Mohammad, Moman A. LU ; Andell, Pontus LU ; Koul, Sasha LU ; Desta, Liyew; Jernberg, Tomas; Omerovic, Elmir; Spaak, Jonas; Fröbert, Ole; Jensen, Jens and Engstrøm, Thomas LU , et al. (2017) In EuroIntervention 13(2). p.210-218
Abstract

Aims: Our aim was to investigate the impact of intravenous (IV) beta-blocker therapy on short-term mortality and other in-hospital events in patients with ST-segment elevation myocardial infarction (STEMI) treated with dual antiplatelet therapy (DAPT) and primary percutaneous coronary intervention (PCI). Methods and results: Using the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we identified all patients with STEMI undergoing PCI between 2006 and 2013. Patients with cardiogenic shock and cardiac arrest at presentation were excluded. The primary endpoint was mortality within 30 days. Secondary endpoints were... (More)

Aims: Our aim was to investigate the impact of intravenous (IV) beta-blocker therapy on short-term mortality and other in-hospital events in patients with ST-segment elevation myocardial infarction (STEMI) treated with dual antiplatelet therapy (DAPT) and primary percutaneous coronary intervention (PCI). Methods and results: Using the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we identified all patients with STEMI undergoing PCI between 2006 and 2013. Patients with cardiogenic shock and cardiac arrest at presentation were excluded. The primary endpoint was mortality within 30 days. Secondary endpoints were in-hospital events (mortality, cardiogenic shock and left ventricular ejection fraction [LVEF] <40% at discharge). We adjusted for confounders with a multivariable model and propensity score matching. Out of 16,909 patients, 2,876 (17.0%) were treated with an IV beta-blocker. After adjusting for confounders, the IV beta-blocker group had higher 30-day all-cause mortality (HR: 1.44, 95% CI: 1.14-1.83), more in-hospital cardiogenic shock (OR: 1.53, 95% CI: 1.09-2.16) and were more often discharged with an LVEF <40% (OR: 1.70, 95% CI: 1.51-1.92). Conclusions: In this large nationwide observational study, the use of IV beta-blockers in patients with STEMI treated with primary PCI was associated with higher short-term mortality, lower LVEF at discharge, as well as a higher risk of in-hospital cardiogenic shock.

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publication status
published
subject
keywords
Adjunctive pharmacotherapy, Clinical research, ST-segment elevation myocardial infarction (STEMI)
in
EuroIntervention
volume
13
issue
2
pages
210 - 218
publisher
Société Europa Edition
external identifiers
  • scopus:85020443252
  • wos:000405133600014
ISSN
1774-024X
DOI
10.4244/EIJ-D-16-01021
language
English
LU publication?
yes
id
f86577e5-8c64-4f47-b639-bbcca135544b
date added to LUP
2017-08-17 12:03:56
date last changed
2017-09-18 11:41:48
@article{f86577e5-8c64-4f47-b639-bbcca135544b,
  abstract     = {<p>Aims: Our aim was to investigate the impact of intravenous (IV) beta-blocker therapy on short-term mortality and other in-hospital events in patients with ST-segment elevation myocardial infarction (STEMI) treated with dual antiplatelet therapy (DAPT) and primary percutaneous coronary intervention (PCI). Methods and results: Using the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we identified all patients with STEMI undergoing PCI between 2006 and 2013. Patients with cardiogenic shock and cardiac arrest at presentation were excluded. The primary endpoint was mortality within 30 days. Secondary endpoints were in-hospital events (mortality, cardiogenic shock and left ventricular ejection fraction [LVEF] &lt;40% at discharge). We adjusted for confounders with a multivariable model and propensity score matching. Out of 16,909 patients, 2,876 (17.0%) were treated with an IV beta-blocker. After adjusting for confounders, the IV beta-blocker group had higher 30-day all-cause mortality (HR: 1.44, 95% CI: 1.14-1.83), more in-hospital cardiogenic shock (OR: 1.53, 95% CI: 1.09-2.16) and were more often discharged with an LVEF &lt;40% (OR: 1.70, 95% CI: 1.51-1.92). Conclusions: In this large nationwide observational study, the use of IV beta-blockers in patients with STEMI treated with primary PCI was associated with higher short-term mortality, lower LVEF at discharge, as well as a higher risk of in-hospital cardiogenic shock.</p>},
  author       = {Mohammad, Moman A. and Andell, Pontus and Koul, Sasha and Desta, Liyew and Jernberg, Tomas and Omerovic, Elmir and Spaak, Jonas and Fröbert, Ole and Jensen, Jens and Engstrøm, Thomas and Hofman-Bang, Claes and Persson, Hans and Erlinge, David},
  issn         = {1774-024X},
  keyword      = {Adjunctive pharmacotherapy,Clinical research,ST-segment elevation myocardial infarction (STEMI)},
  language     = {eng},
  month        = {06},
  number       = {2},
  pages        = {210--218},
  publisher    = {Société Europa Edition},
  series       = {EuroIntervention},
  title        = {Intravenous beta-blocker therapy in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention is not associated with benefit regarding short-term mortality : A Swedish nationwide observational study},
  url          = {http://dx.doi.org/10.4244/EIJ-D-16-01021},
  volume       = {13},
  year         = {2017},
}