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      Effect of β‐Blockers Beyond 3 Years After Acute Myocardial Infarction

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          Abstract

          Background

          The optimal duration of β‐blocker therapy in patients with acute myocardial infarction ( AMI) is unknown. We aimed to evaluate the late effect of β‐blockers in patients with AMI.

          Methods and Results

          We enrolled all consecutive patients who presented with AMI at Seoul National University Bundang Hospital, between June 3, 2003 and February 24, 2015. The primary end point was 5‐year all‐cause mortality, depending on the use of β‐blockers at discharge, 1 year after AMI, and 3 years after AMI. Of 2592 patients, the prescription rates of β‐blockers were 72%, 69%, 63%, and 60% at discharge and 1, 3, and 5 years after AMI, respectively. The patients who were receiving β‐blocker therapy had more favorable clinical characteristics, such as younger age (62 versus 65 years; P<0.001). They received reperfusion therapy more often (92% versus 80%; P<0.001) than those without β‐blocker prescription. In the univariate analysis, the patients with β‐blocker prescription had lower 5‐year mortality at all time points. In the Cox model after adjustment for significant covariates, β‐blocker prescription at discharge was associated with a 29% reduced mortality risk (hazard ratio, 0.71; 95% confidence interval, 0.55–0.90; P=0.006); however, β‐blocker prescriptions at 1 and 3 years after AMI were not associated with reduced mortality.

          Conclusions

          The beneficial effect of β‐blocker therapy after AMI may be limited until 1 year after AMI. Whether late β‐blocker therapy beyond 1 year after AMI offers clinical benefits should be confirmed in further clinical trials.

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          Most cited references 33

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          Third universal definition of myocardial infarction.

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            2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

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              2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

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                Author and article information

                Contributors
                kunson2@snu.ac.kr
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                03 March 2018
                06 March 2018
                : 7
                : 5 ( doiID: 10.1002/jah3.2018.7.issue-5 )
                Affiliations
                [ 1 ] Cardiovascular Center Seoul National University Bundang Hospital Seongnam Korea
                Author notes
                [* ] Correspondence to: Chang‐Hwan Yoon, MD, PhD, Cardiovascular Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, 82 Gumiro 173, Bundang, Seongnam, Korea. E‐mail: kunson2@ 123456snu.ac.kr
                Article
                JAH33014
                10.1161/JAHA.117.007567
                5866322
                29502101
                © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                Page count
                Figures: 6, Tables: 4, Pages: 16, Words: 8388
                Product
                Funding
                Funded by: Research of Korea Centers for Disease Control and Prevention
                Award ID: 2011‐E63009‐00
                Funded by: Industrial Strategic Technology Development Program
                Award ID: 10052980
                Funded by: Ministry of Trade, Industry, and Energy
                Funded by: Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea
                Award ID: HI17C1799
                Funded by: SNUBH Research Fund
                Award ID: 14‐2017‐012
                Categories
                Original Research
                Original Research
                Coronary Heart Disease
                Custom metadata
                2.0
                jah33014
                06 March 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.2.2 mode:remove_FC converted:06.03.2018

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