Stefano Coiro1,2,3, Nicolas Girerd1,2, Patrick Rossignol1,2, João Pedro Ferreira1,2,4, Aldo Maggioni5, Bertram Pitt6, Isabella Tritto3, Giuseppe Ambrosio3, Kenneth Dickstein7, Faiez Zannad1,2. 1. INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France. 2. INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France. 3. Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy. 4. Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal. 5. ANMCO Research Centre, Firenze, Italy. 6. Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI, USA. 7. University of Bergen, Stavanger University Hospital, Stavanger, Norway.
Abstract
AIMS: To determine the influence of baseline beta-blocker use on long-term prognosis of myocardial infarction (MI) survivors complicated with heart failure (HF) or with left ventricular dysfunction and with history of chronic obstructive pulmonary disease (COPD). METHODS AND RESULTS: Among the 28 771 patients from the High-Risk MI Database Initiative we identified 1573 patients with a baseline history of COPD. We evaluated the association between beta-blocker use at baseline (822 with beta-blocker and 751 without) on the rates of all-cause and cardiovascular mortality. On univariable Cox analysis, beta-blocker use was found to be associated with lower rates of both all-cause [hazard ratio (HR) = 0.61, 95% confidence interval (CI) 0.51-0.75, P < 0.0001] and cardiovascular mortality (HR = 0.63, 95% CI 0.51-0.78, P < 0.0001). After extensive adjustment for confounding, including 24 baseline covariates, COPD patients still benefited from beta-blocker usage (HR = 0.73, 95% CI 0.60-0.90, P = 0.002 for all-cause mortality; HR = 0.77, 95% CI 0.61-0.97, P = 0.025 for cardiovascular mortality). Adjusting for propensity scores (PS) constructed from the 24 aforementioned baseline characteristics provided similar results. In a cohort of 561 pairs of patients taking or not taking beta-blocker matched on PS using a 1:1 nearest-neighbour matching method, patients treated with beta-blocker experienced fewer all-cause deaths (HR = 0.71, 95% CI 0.56-0.89, P = 0.003) and cardiovascular deaths (HR = 0.76, 95% CI 0.59-0.97, P = 0.032). CONCLUSIONS: In the specific setting of a well-treated cohort of high-risk MI survivors, beta-blockers were associated with better outcomes in patients with COPD.
AIMS: To determine the influence of baseline beta-blocker use on long-term prognosis of myocardial infarction (MI) survivors complicated with heart failure (HF) or with left ventricular dysfunction and with history of chronic obstructive pulmonary disease (COPD). METHODS AND RESULTS: Among the 28 771 patients from the High-Risk MI Database Initiative we identified 1573 patients with a baseline history of COPD. We evaluated the association between beta-blocker use at baseline (822 with beta-blocker and 751 without) on the rates of all-cause and cardiovascular mortality. On univariable Cox analysis, beta-blocker use was found to be associated with lower rates of both all-cause [hazard ratio (HR) = 0.61, 95% confidence interval (CI) 0.51-0.75, P < 0.0001] and cardiovascular mortality (HR = 0.63, 95% CI 0.51-0.78, P < 0.0001). After extensive adjustment for confounding, including 24 baseline covariates, COPDpatients still benefited from beta-blocker usage (HR = 0.73, 95% CI 0.60-0.90, P = 0.002 for all-cause mortality; HR = 0.77, 95% CI 0.61-0.97, P = 0.025 for cardiovascular mortality). Adjusting for propensity scores (PS) constructed from the 24 aforementioned baseline characteristics provided similar results. In a cohort of 561 pairs of patients taking or not taking beta-blocker matched on PS using a 1:1 nearest-neighbour matching method, patients treated with beta-blocker experienced fewer all-cause deaths (HR = 0.71, 95% CI 0.56-0.89, P = 0.003) and cardiovascular deaths (HR = 0.76, 95% CI 0.59-0.97, P = 0.032). CONCLUSIONS: In the specific setting of a well-treated cohort of high-risk MI survivors, beta-blockers were associated with better outcomes in patients with COPD.
Authors: Jesús Recio Iglesias; Jesús Díez-Manglano; Francisco López García; José Antonio Díaz Peromingo; Pere Almagro; José Manuel Varela Aguilar Journal: Int J Chron Obstruct Pulmon Dis Date: 2020-05-07
Authors: Markus S Anker; Alessia Lena; Sara Hadzibegovic; Yury Belenkov; Jutta Bergler-Klein; Rudolf A de Boer; Alain Cohen-Solal; Dimitrios Farmakis; Stephan von Haehling; Teresa López-Fernández; Radek Pudil; Thomas Suter; Carlo G Tocchetti; Alexander R Lyon Journal: ESC Heart Fail Date: 2018-12