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β blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study.

Authors
  • Puymirat, Etienne1
  • Riant, Elisabeth2
  • Aissaoui, Nadia3
  • Soria, Angèle4
  • Ducrocq, Gregory5
  • Coste, Pierre6
  • Cottin, Yves7
  • Aupetit, Jean François8
  • Bonnefoy, Eric9
  • Blanchard, Didier10
  • Cattan, Simon11
  • Steg, Gabriel5
  • Schiele, François12
  • Ferrières, Jean13
  • Juillière, Yves14
  • Simon, Tabassome15
  • Danchin, Nicolas2
  • 1 Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France [email protected] , (France)
  • 2 Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France. , (France)
  • 3 Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France Department of Critical Care, Hôpital Européen Georges Pompidou, Paris, France. , (France)
  • 4 Assistance Publique-Hôpitaux de Paris, Paris, France Department of Dermatology and Allergology, Tenon Hospital, Paris, France Sorbonne University, Université Pierre et Marie Curie (UPMC-Paris 06), Paris, France INSERM U1135-CIMI, Paris, France. , (France)
  • 5 Assistance Publique-Hôpitaux de Paris, Paris, France Hôpital Bichat, Paris, France Université Paris Diderot, Paris, France INSERM U 698, Paris, France. , (France)
  • 6 Hôpital cardiologique du Haut Levêque, Pessac, France Université Bordeaux Segalen, Bordeaux, France. , (France)
  • 7 Hôpital du Bocage, Dijon, France Université de Bourgogne, Dijon, France. , (France)
  • 8 Hôpital St Joseph et St Luc, Lyon, France. , (France)
  • 9 Hôpital cardiologique Louis Pradel, Lyon, France Université Lyon 1, Lyon, France. , (France)
  • 10 Clinique St Gatien, Tours, France. , (France)
  • 11 Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France. , (France)
  • 12 Hôpital Jean Minjoz, Besançon, France Université de Franche Comté, Besançon, France. , (France)
  • 13 Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France UMR INSERM 1027, Toulouse, France. , (France)
  • 14 Institut Lorrain du Cœur et des Vaisseaux Université de Lorraine, Nancy, France. , (France)
  • 15 Assistance Publique-Hôpitaux de Paris, Paris, France Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France. , (France)
Type
Published Article
Journal
BMJ
Publisher
BMJ
Publication Date
Sep 20, 2016
Volume
354
Identifiers
DOI: 10.1136/bmj.i4801
PMID: 27650822
Source
Medline
Language
English
License
Unknown

Abstract

To assess the association between early and prolonged β blocker treatment and mortality after acute myocardial infarction. Multicentre prospective cohort study. Nationwide French registry of Acute ST- and non-ST-elevation Myocardial Infarction (FAST-MI) (at 223 centres) at the end of 2005. 2679 consecutive patients with acute myocardial infarction and without heart failure or left ventricular dysfunction. Mortality was assessed at 30 days in relation to early use of β blockers (≤48 hours of admission), at one year in relation to discharge prescription, and at five years in relation to one year use. β blockers were used early in 77% (2050/2679) of patients, were prescribed at discharge in 80% (1783/2217), and were still being used in 89% (1230/1383) of those alive at one year. Thirty day mortality was lower in patients taking early β blockers (adjusted hazard ratio 0.46, 95% confidence interval 0.26 to 0.82), whereas the hazard ratio for one year mortality associated with β blockers at discharge was 0.77 (0.46 to 1.30). Persistence of β blockers at one year was not associated with lower five year mortality (hazard ratio 1.19, 0.65 to 2.18). In contrast, five year mortality was lower in patients continuing statins at one year (hazard ratio 0.42, 0.25 to 0.72) compared with those discontinuing statins. Propensity score and sensitivity analyses showed consistent results. Early β blocker use was associated with reduced 30 day mortality in patients with acute myocardial infarction, and discontinuation of β blockers at one year was not associated with higher five year mortality. These findings question the utility of prolonged β blocker treatment after acute myocardial infarction in patients without heart failure or left ventricular dysfunction.Trial registration Clinical trials NCT00673036. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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