Beta-blocker prescription and outcomes in uncomplicated acute myocardial infarction: Insight from the ePARIS registry.

Humans Stroke Volume Ventricular Function, Left Prospective Studies Myocardial Infarction / diagnosis Ventricular Dysfunction, Left Prescriptions Adrenergic beta-Antagonists / adverse effects Registries
Beta-blocker Coronary intervention Myocardial infarction

Journal

Archives of cardiovascular diseases
ISSN: 1875-2128
Titre abrégé: Arch Cardiovasc Dis
Pays: Netherlands
ID NLM: 101465655

Informations de publication

Date de publication:
Jan 2023
Historique:
received: 31 05 2022
revised: 16 09 2022
accepted: 25 10 2022
pubmed: 23 12 2022
medline: 9 2 2023
entrez: 22 12 2022
Statut: ppublish

Résumé

Systematic prescription of beta-blockers after myocardial infarction remains an open question in the era of revascularization, especially for patients with uncomplicated myocardial infarction. To evaluate in a real-life registry the proportion of patients with uncomplicated myocardial infarction (preserved left ventricular ejection fraction and no cardiovascular event within the first 6 months), and to report their characteristics, outcomes and beta-blocker use. We included 1887 consecutive patients with ST-segment elevation myocardial infarction from the prospective ePARIS registry. Patients were divided into three groups: the "uncomplicated myocardial infarction" group (n=1060), defined by a left ventricular ejection fraction ≥ 40% and a 6-month period free from cardiovascular events; the "complicated myocardial infarction" group (n=366), defined by a left ventricular ejection fraction ≥ 40% and a recurrent cardiovascular event in the first 6 months; and the "left ventricular dysfunction" group (n=461), defined by a left ventricular ejection fraction<40%. During a median follow-up of 2.7 years (interquartile range 1.0-4.9 years), the "uncomplicated myocardial infarction" group was at low mortality risk compared with the "complicated myocardial infarction" group (hazard ratio 0.38, 95% confidence interval 0.25-0.58; P<0.01) and the "left ventricular dysfunction" group (hazard ratio 0.22, 95% confidence interval 0.15-0.32; P<0.01). Beta-blockers were prescribed at discharge predominantly in the "uncomplicated myocardial infarction" group (93%) compared with 87% in the "complicated myocardial infarction" group and 81% in the "left ventricular dysfunction" group. Beta-blockers are less prescribed in patients who may need them the most. The benefit of beta-blockers-largely prescribed in lower-risk patients-remains to be shown beyond the first 6 months for these patients with no left ventricular dysfunction and no recurrent events.

Sections du résumé

BACKGROUND BACKGROUND
Systematic prescription of beta-blockers after myocardial infarction remains an open question in the era of revascularization, especially for patients with uncomplicated myocardial infarction.
OBJECTIVE OBJECTIVE
To evaluate in a real-life registry the proportion of patients with uncomplicated myocardial infarction (preserved left ventricular ejection fraction and no cardiovascular event within the first 6 months), and to report their characteristics, outcomes and beta-blocker use.
METHODS METHODS
We included 1887 consecutive patients with ST-segment elevation myocardial infarction from the prospective ePARIS registry. Patients were divided into three groups: the "uncomplicated myocardial infarction" group (n=1060), defined by a left ventricular ejection fraction ≥ 40% and a 6-month period free from cardiovascular events; the "complicated myocardial infarction" group (n=366), defined by a left ventricular ejection fraction ≥ 40% and a recurrent cardiovascular event in the first 6 months; and the "left ventricular dysfunction" group (n=461), defined by a left ventricular ejection fraction<40%.
RESULTS RESULTS
During a median follow-up of 2.7 years (interquartile range 1.0-4.9 years), the "uncomplicated myocardial infarction" group was at low mortality risk compared with the "complicated myocardial infarction" group (hazard ratio 0.38, 95% confidence interval 0.25-0.58; P<0.01) and the "left ventricular dysfunction" group (hazard ratio 0.22, 95% confidence interval 0.15-0.32; P<0.01). Beta-blockers were prescribed at discharge predominantly in the "uncomplicated myocardial infarction" group (93%) compared with 87% in the "complicated myocardial infarction" group and 81% in the "left ventricular dysfunction" group.
CONCLUSIONS CONCLUSIONS
Beta-blockers are less prescribed in patients who may need them the most. The benefit of beta-blockers-largely prescribed in lower-risk patients-remains to be shown beyond the first 6 months for these patients with no left ventricular dysfunction and no recurrent events.

Identifiants

DOI: 10.1016/j.acvd.2022.10.007 PMID: 36549972
pubmed: 36549972
pii: S1875-2136(22)00229-7
doi: 10.1016/j.acvd.2022.10.007
pii:
doi:

Substances chimiques

Adrenergic beta-Antagonists 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

25-32

Informations de copyright

Copyright © 2022 Elsevier Masson SAS. All rights reserved.

Auteurs

Gaspard Suc (G)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Michel Zeitouni (M)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Niki Procopi (N)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Paul Guedeney (P)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Mathieu Kerneis (M)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Olivier Barthelemy (O)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Claude Le Feuvre (C)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Gérard Helft (G)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Stéphanie Rouanet (S)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; StatEthic, 92300 Levallois-Perret, France.

Delphine Brugier (D)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Jean-Philippe Collet (JP)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Eric Vicaut (E)

Unité de recherche clinique, ACTION Study Group, Hôpital Fernand-Widal, AP-HP, 75010 Paris, France; Statistique, Analyse et Modélisation Multidisciplinaire (SAMM), EA 4543, Université Paris 1 Panthéon Sorbonne, 75013 Paris, France.

Gilles Montalescot (G)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.

Johanne Silvain (J)

Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France. Electronic address: johanne.silvain@aphp.fr.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Beta-blocker prescription and outcomes in...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Hémodynamique › Débit cardiaque › Débit systolique › Beta-blocker prescription and outcomes in...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Fonction ventriculaire › Fonction ventriculaire gauche › Beta-blocker prescription and outcomes in...
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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Beta-blocker prescription and outcomes in...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Dysfonction ventriculaire › Dysfonction ventriculaire gauche › Beta-blocker prescription and outcomes in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services pharmaceutiques › Ordonnances › Beta-blocker prescription and outcomes in...
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questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enregistrements › Beta-blocker prescription and outcomes in...