Doyeon Hwang1, Joo Myung Lee2, Hyun Kuk Kim3, Ki Hong Choi2, Tae-Min Rhee1,4, Jonghanne Park1, Taek Kyu Park2, Jeong Hoon Yang2, Young Bin Song2, Jin-Ho Choi2, Joo-Yong Hahn2, Seung-Hyuk Choi2, Bon-Kwon Koo1, Young Jo Kim5, Shung-Chull Chae6, Myeong Chan Cho7, Chong Jin Kim8, Hyeon-Cheol Gwon2, Myung Ho Jeong9, Hyo-Soo Kim1. 1. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital. 2. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine. 3. Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine. 4. National Maritime Medical Center. 5. Department of Cardiology, Yeungnam University Medical Center. 6. School of Medicine, Kyungpook National University. 7. Cardiology Division, Department of Internal Medicine, Chungbuk National University Hospital. 8. Department of Internal Medicine, Kyunghee University College of Medicine. 9. Department of Internal Medicine and Heart Center, Chonnam National University Hospital.
Abstract
BACKGROUND: The differential prognostic impact of β-blocker dose after acute myocardial infarction (AMI) has been under debate. The current study sought to compare clinical outcome after AMI according to β-blocker dose using the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH). Methods and Results: Of the total population of 13,104 consecutive AMI patients enrolled in the KAMIR-NIH, the current study analyzed 11,909 patients. These patients were classified into 3 groups (no β-blocker; low-dose [<25% of target dose]; and high-dose [≥25% of target dose]). The primary outcome was cardiac death at 1 year. Compared with the no β-blocker group, both the low-dose and high-dose groups had significantly lower risk of cardiac death (HR, 0.435; 95% CI: 0.363-0.521, P<0.001; HR, 0.519; 95% CI: 0.350-0.772, P=0.001, respectively). The risk of cardiac death, however, was similar between the high- and low-dose groups (HR, 1.194; 95% CI: 0.789-1.808, P=0.402). On multivariable adjustment and inverse probability weighted analysis, the result was the same. CONCLUSIONS: The use of β-blockers in post-AMI patients had significant survival benefit compared with no use of β-blockers. There was no significant additional benefit of high-dose β-blockers compared with low-dose β-blockers, however, in terms of 1-year risk of cardiac death.
BACKGROUND: The differential prognostic impact of β-blocker dose after acute myocardial infarction (AMI) has been under debate. The current study sought to compare clinical outcome after AMI according to β-blocker dose using the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH). Methods and Results: Of the total population of 13,104 consecutive AMI patients enrolled in the KAMIR-NIH, the current study analyzed 11,909 patients. These patients were classified into 3 groups (no β-blocker; low-dose [<25% of target dose]; and high-dose [≥25% of target dose]). The primary outcome was cardiac death at 1 year. Compared with the no β-blocker group, both the low-dose and high-dose groups had significantly lower risk of cardiac death (HR, 0.435; 95% CI: 0.363-0.521, P<0.001; HR, 0.519; 95% CI: 0.350-0.772, P=0.001, respectively). The risk of cardiac death, however, was similar between the high- and low-dose groups (HR, 1.194; 95% CI: 0.789-1.808, P=0.402). On multivariable adjustment and inverse probability weighted analysis, the result was the same. CONCLUSIONS: The use of β-blockers in post-AMI patients had significant survival benefit compared with no use of β-blockers. There was no significant additional benefit of high-dose β-blockers compared with low-dose β-blockers, however, in terms of 1-year risk of cardiac death.
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