Lack of Effect of Oral Beta-Blocker Therapy at Discharge on Long-Term Clinical Outcomes of ST-Segment Elevation Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention

Beta-blocker therapy is recommended after ST-segment elevation acute myocardial infarction (STEMI) in current guidelines, although its efficacy in those patients who have undergone primary percutaneous coronary intervention (PCI) has not been adequately evaluated Of 12,824 consecutive patients who underwent sirolimus-eluting stent implantation in the J-Cypher registry, we identified 910 patients who underwent PCI within 24 hours from onset of STEMI Three-year outcomes were evaluated according to use of 13 blockers at hospital discharge (349 patients in beta-blocker group and 561 patients in no-beta-blocker group) Patients in the beta-blocker group more frequently had hypertension, low left ventricular ejection fraction (LVEF), a left anterior descending artery infarct, and statin use than those in the no-beta-blocker group No difference was observed between the B-blocker and no-beta-blocker groups in mortality (6 6% vs 6 6%, p = 0 85, propensity score adjusted hazard ratio 110, 95% confidence interval 064 to 1 90, p = 0 70) or in incidence of major adverse cardiac events (all-cause death, recurrent myocardial infarction, and heart failure hospitalization, 13 5% vs 12 1%, p = 0 91, hazard ratio 1 13, 95% confidence interval 0 76 to 1 66, p = 0 53) Better outcomes were observed in the B-blocker group than in the no-beta-blocker group in a subgroup of patients with LVEF <= 40% (n = 125, death 6 4% vs 17 4%, p = 0 04, major adverse cardiac events 14 5% vs 31 8%, p = 0 009) In conclusion, beta-blocker therapy was not associated with better 3-year clinical outcomes in patients with STEMI who underwent primary PCI and had preserved LVEF (C) 2010 Elsevier Inc All rights reserved (Am J Cardiol 2010,106 1225-1233)