Admission Heart Rate Is a Determinant of Effectiveness of Beta-Blockers in Acute Myocardial Infarction Patients

被引：8

作者：

Okuno, Taishi ^{[1
]}

Aoki, Jiro ^{[1
]}

Tanabe, Kengo ^{[1
]}

Nakao, Koichi ^{[2
]}

Ozaki, Yukio ^{[3
]}

Kimura, Kazuo ^{[4
]}

Ako, Junya ^{[5
]}

Noguchi, Teruo ^{[6
]}

Yasuda, Satoshi ^{[6
]}

Suwa, Satoru ^{[8
]}

Fujimoto, Kazuteru ^{[9
]}

Nakama, Yasuharu ^{[10
]}

Morita, Takashi ^{[11
]}

Shimizu, Wataru ^{[12
]}

Saito, Yoshihiko ^{[13
]}

Hirohata, Atsushi ^{[14
]}

Morita, Yasuhiro ^{[15
]}

Inoue, Teruo ^{[16
]}

Okamura, Atsunori ^{[17
]}

Mano, Toshiaki ^{[18
]}

Hirata, Kazuhito ^{[19
]}

Shibata, Yoshisato ^{[20
]}

Owa, Mafumi ^{[21
]}

Tsujita, Kenichi ^{[22
]}

Funayama, Hiroshi ^{[23
]}

Kokubu, Nobuaki ^{[24
]}

Kozuma, Ken ^{[25
]}

Uemura, Shiro ^{[26
]}

Tobaru, Tetsuya ^{[27
]}

Saku, Keijiro ^{[28
]}

Ohshima, Shigeru ^{[29
]}

Nishimura, Kunihiro ^{[7
]}

Miyamoto, Yoshihiro ^{[7
]}

Ogawa, Hisao ^{[30
]}

Ishihara, Masaharu ^{[31
]}

机构：

[1] Mitsui Mem Hosp, Div Cardiol, Tokyo, Japan

[2] Saiseikai Kumamoto Hosp, Ctr Cardiovasc, Div Cardiol, Kumamoto, Japan

[3] Fujita Hlth Univ Hosp, Dept Cardiol, Toyoake, Aichi, Japan

[4] Yokohama City Univ, Med Ctr, Ctr Cardiovasc, Yokohama, Kanagawa, Japan

[5] Kitasato Univ, Dept Cardiovasc Med, Sagamihara, Kanagawa, Japan

[6] Natl Cerebral & Cardiovasc Ctr, Dept Cardiovasc Med, Suita, Osaka, Japan

[7] Natl Cerebral & Cardiovasc Ctr, Dept Prevent Cardiol, Suita, Osaka, Japan

[8] Juntendo Univ, Shizuoka Hosp, Dept Cardiol, Shizuoka, Japan

[9] Natl Hosp Org Kumamoto Med Ctr, Dept Cardiol, Kumamoto, Japan

[10] Hiroshima City Hosp, Dept Cardiol, Hiroshima, Japan

[11] Osaka Gen Med Ctr, Div Cardiol, Osaka, Japan

[12] Nippon Med Sch, Dept Cardiovasc Med, Tokyo, Japan

[13] Nara Med Univ, Dept Internal Med 1, Kashihara, Nara, Japan

[14] Sakakibara Heart Inst Okayama, Dept Cardiovasc Med, Okayama, Japan

[15] Ogaki Municipal Hosp, Dept Cardiol, Ogaki, Japan

[16] Dokkyo Med Univ, Dept Cardiovasc Med, Mibu, Tochigi, Japan

[17] Sakurabashi Watanabe Hosp, Dept Cardiol, Osaka, Japan

[18] Kansai Rosai Hosp, Ctr Cardiovasc, Amagasaki, Hyogo, Japan

[19] Okinawa Prefectural Chubu Hosp, Dept Cardiol, Uruma, Japan

[20] Miyazaki Med Assoc Hosp, Dept Cardiol, Miyazaki, Japan

[21] Suwa Red Cross Hosp, Dept Cardiovasc Med, Suwa, Japan

[22] Kumamoto Univ, Grad Sch Med Sci, Dept Cardiovasc Med, Kumamoto, Japan

[23] Jichi Med Univ, Saitama Med Ctr, Div Cardiovasc Med, Saitama, Japan

[24] Sapporo Med Sch, Dept Cardiovasc Renal & Metab Med, Sapporo, Hokkaido, Japan

[25] Teikyo Univ, Dept Cardiol, Tokyo, Japan

[26] Kawasaki Med Sch, Dept Cardiol, Kurashiki, Okayama, Japan

[27] Sakakibara Heart Inst, Dept Cardiol, Tokyo, Japan

[28] Fukuoka Univ, Sch Med, Dept Cardiol, Fukuoka, Fukuoka, Japan

[29] Gunma Prefectural Cardiovasc Ctr, Dept Cardiol, Maebashi, Gunma, Japan

[30] Natl Cerebral & Cardiovasc Ctr, Suita, Osaka, Japan

[31] Hyogo Coll Med, Div Coronary Artery Dis, Nishinomiya, Hyogo, Japan

来源：

CIRCULATION JOURNAL | 2019年 / 83卷 / 05期

关键词：

Acute myocardial infarction; Beta-blockers; Heart rate; ST-SEGMENT ELEVATION; PERCUTANEOUS CORONARY INTERVENTION; CLINICAL-OUTCOMES; RANDOMIZED-TRIAL; EUROPEAN-SOCIETY; MORTALITY; THERAPY; DISCHARGE; BLOCKADE; METAANALYSIS;

D O I：

10.1253/circj.CJ-18-0995

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Beta-blockers are standard therapy for acute myocardial infarction (AMI). However, despite current advances in the management of AMI, it remains unclear whether all AMI patients benefit from beta-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of beta-blockers for AMI patients. Methods and Results: We enrolled 3,283 consecutive AMI patients who were admitted to 28 participating institutions in the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) study. According to admission HR, we divided patients into 3 groups: bradycardia (HR <60 beats/min, n=444), normocardia (HR 60 to <= 100 beats/min, n=2,013), and tachycardia (HR > 100 beats/min, n=342). The primary endpoint was major adverse cardiac events (MACE), including all-cause death, non-fatal MI, non-fatal stroke, heart failure (HF), and urgent revascularization for unstable angina, at 3-year follow-up. Beta-blocker at discharge was significantly associated with a lower risk of MACE in the tachycardia group (23.6% vs. 33.0%; P=0.033), but it did not affect rates of MACE in the normocardia group (17.8% vs. 18.4%; P=0.681). In the bradycardia group, beta-blocker use at discharge was significantly associated with a higher risk of MACE (21.6% vs. 12.7%; P=0.026). Results were consistent for multivariable regression and stepwise multivariable regression. Conclusions: Admission HR might determine the efficacy of beta-blockers for current AMI patients.

引用

页码：1054 / +

页数：14

共 40 条

[21] Does beta-blocker therapy improve clinical outcomes of acute myocardial infarction after successful primary angioplasty? [J].