One‐Year Landmark Analysis of the Effect of Beta‐Blocker Dose on Survival After Acute Myocardial Infarction
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Published:2021-07-20
Issue:14
Volume:10
Page:
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ISSN:2047-9980
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Container-title:Journal of the American Heart Association
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language:en
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Short-container-title:JAHA
Author:
Goldberger Jeffrey J.1ORCID, Subačius Haris2, Marroquin Oscar C.3, Beau Scott L.4, Simonson Jay5, Desai P., Betzen M., DeLuna D., Whitehill J., Hatch J., Janak L., Cherry R., Gonzalez E., Cruz I., Johnson E., Allbritton C., Derrick V., Fishman R., Assalone V., Mahon L., Lustgarten D., Rowen M., Bessette M., Alemy B., Dan D., Picardi K., Schuger C., Dzidowski J., McCarthy M., Fields P., Alexander S., Nair G., Kovacs R., Beasley D., Strickland T., Marks J., Beau S., Tableriou J., Griffin B., Shani J., Stokes‐McCarthy M., Tan‐Augenstein G., Pace G., Brosnan H., Hayes J., Mancl K., Maassen K., Fintel D., Karpf L., Abraham T., Campione K., Martin E., Bello D., Viera Fleetwood I., Tinetti M., Rock R., Simonson J., Barnes S., Letexier J., Strothman M., Mattson J., Albert Shoultz C., Ali S., Abbott D., Medeiros M., McKeon J., Nichols A., Edwards T., Watts C., Alley C., Romanelli M., Steffen D., Henschel R., Teller S., Froehlich L., Bess R., Warnica W., Smith B., Eichman D., Scarcelli D., Badhwar N., Malone P., Green D., Iyer S., Germany R., Murray C., Straughn G., Drennan K., Marroquin O., Dennis L., Farrow C., Baxendell L., Grate S., Enlow M., Zareba W., Chaudhary I., Laduke P., Conary‐Rocco V., Caufield L., Patterson C., Warner A., Johnson J., Germano J., Drewes W., George B., Yoo B., Patel D., Bonow R., Cuffe M., Dyer A., Greenland P., Goldberger J., O’Rourke R., Rosenberg Y., Shah P., Byington R., Feng Z., Goldstein S., Kirkpatrick J., Love C., Singh S., Rosenberg Y., Goldberg S., Kwak M., Rao A., Srinivas P., Goldberger J., Ball C., Cahill J., Schaechter A., Alexander D., Ma K., Plant T., Rosenfeld A., Scofic J., Simon J., Subačius H.
Affiliation:
1. University of Miami Miller School of Medicine Miami FL 2. Division of Research and Optimal Patient Care American College of Surgeons Chicago IL 3. UPMC Heart and Vascular Institute and Division of Cardiology University of Pittsburgh PA 4. Arkansas Heart Hospital Little Rock AR 5. Park Nicollet Methodist Hospital St. Louis Park MN
Abstract
Background
Although beta‐blockers are recommended following myocardial infarction (MI), the benefits of long‐term treatment have not been established. The study's aim was to evaluate beta‐blocker efficacy by dose in 1‐year post‐MI survivors.
Methods and Results
The OBTAIN (Outcomes of Beta‐Blocker Therapy After Myocardial Infarction) registry included 7057 patients with acute MI, with 6077 one‐year survivors. For this landmark analysis, beta‐blocker dose status was available in 3004 patients and analyzed by use (binary) and dose at 1 year after MI. Doses were classified as no beta‐blocker and >0% to 12.5%, >12.5% to 25%, >25% to 50%, and >50% of target doses used in randomized clinical trials. Age was 63 to 64 years, and approximately two thirds were men. Median follow‐up duration was 1.05 years (interquartile range, 0.98–1.22). When analyzed dichotomously, beta‐blocker therapy was not associated with improved survival. When analyzed by dose, propensity score analysis showed significantly increased mortality in the no–beta‐blocker group (hazard ratio,1.997; 95% CI, 1.118–3.568;
P
<0.02), the >0% to 12.5% group (hazard ratio, 1.817; 95% CI, 1.094–3.016;
P
<0.02), and the >25% to 50% group (hazard ratio, 1.764; 95% CI, 1.105–2.815;
P
<0.02), compared with the >12.5% to 25% dose group. The mortality in the full‐dose group was not significantly higher (hazard ratio, 1.196; 95% CI, 0.687–2.083). In subgroup analyses, only history of congestive heart failure demonstrated significant interaction with beta‐blocker effects on survival.
Conclusions
This analysis suggests that patients treated with >12.5% to 25% of the target dose used in prior randomized clinical trials beyond 1 year after MI may have enhanced survival compared with no beta‐blocker and other beta‐blocker doses. A new paradigm for post‐MI beta‐blocker therapy is needed that addresses which patients should be treated, for how long, and at what dose.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
17 articles.
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