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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
Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
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2017 (English)In: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 13, no 2, E210-E218 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Europa Edition , 2017. Vol. 13, no 2, E210-E218 p.
Keyword [en]
adjunctive pharmacotherapy, clinical research, ST-segment elevation myocardial infarction (STEMI)
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-59137DOI: 10.4244/EIJ-D-16-01021ISI: 000405133600014PubMedID: 28242589Scopus ID: 2-s2.0-85020443252OAI: oai:DiVA.org:oru-59137DiVA: diva2:1135193
Funder
Swedish Heart Lung FoundationSwedish Research Council
Note

Funding Agencies:

SSF (TOTAL-AMI)   

Knut and Alice Wallenbergs Foundation  

ALF  

Skåne University Hospital 

Available from: 2017-08-22 Created: 2017-08-22 Last updated: 2017-10-18Bibliographically approved

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