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      Differing effects of beta-blockers on long-term clinical outcomes following percutaneous coronary intervention between patients with mid-range and reduced left ventricular ejection fraction

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          Abstract

          Background

          The aim of this study was to determine the difference in effects of beta-blockers on long-term clinical outcomes between ischemic heart disease (IHD) patients with mid-range ejection fraction (mrEF) and those with reduced ejection fraction (rEF).

          Methods

          Data were assessed of 3508 consecutive IHD patients who underwent percutaneous coronary intervention (PCI) between 1997 and 2011. Among them, 316 patients with mrEF (EF = 40–49%) and 201 patients with rEF (EF < 40%) were identified. They were assigned to groups according to users and non-users of beta-blockers and effects of beta-blockers were assessed between mrEF and rEF patients, separately. The primary outcome was a composite of all-cause death and non-fatal acute coronary syndrome.

          Results

          The median follow-up period was 5.5 years in mrEF patients and 4.3 years in rEF patients. Cumulative event-free survival was significantly lower in the group with beta-blockers than in the group without beta-blockers in rEF ( p = 0.003), whereas no difference was observed in mrEF ( p = 0.137) between those with and without beta-blockers. In the multivariate analysis, use of beta-blockers was associated with reduction in clinical outcomes in patients with rEF (hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.36–0.97; p = 0.036), whereas no association was observed among those with mrEF (HR 0.74; 95% CI 0.49–1.10; p = 0.137).

          Conclusions

          Our observational study showed that use of beta-blockers was not associated with long-term clinical outcomes in IHD patients with mrEF, whereas a significant association was observed in those with rEF.

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          Most cited references23

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          2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

          Héctor Bueno, Borja Ibanez, Stefan James … (2017)
          Article 0 comments Cited 2245 times – based on 0 reviews     Review now
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            Revised equations for estimated GFR from serum creatinine in Japan.

            Seiichi Matsuo, Enyu Imai, Masaru Horio … (2009)
            Estimation of glomerular filtration rate (GFR) is limited by differences in creatinine generation among ethnicities. Our previously reported GFR-estimating equations for Japanese had limitations because all participants had a GFR less than 90 mL/min/1.73 m2 and serum creatinine was assayed in different laboratories. Diagnostic test study using a prospective cross-sectional design. New equations were developed in 413 participants and validated in 350 participants. All samples were assayed in a central laboratory. Hospitalized Japanese patients in 80 medical centers. Patients had not participated in the previous study. Measured GFR (mGFR) computed from inulin clearance. Estimated GFR (eGFR) by using the modified isotope dilution mass spectrometry (IDMS)-traceable 4-variable Modification of Diet in Renal Disease (MDRD) Study equation using the previous Japanese Society of Nephrology Chronic Kidney Disease Initiative (JSN-CKDI) coefficient of 0.741 (equation 1), the previous JSN-CKDI equation (equation 2), and new equations derived in the development data set: modified MDRD Study using a new Japanese coefficient (equation 3), and a 3-variable Japanese equation (equation 4). Performance of equations was assessed by means of bias (eGFR - mGFR), accuracy (percentage of estimates within 15% or 30% of mGFR), root mean squared error, and correlation coefficient. In the development data set, the new Japanese coefficient was 0.808 (95% confidence interval, 0.728 to 0.829) for the IDMS-MDRD Study equation (equation 3), and the 3-variable Japanese equation (equation 4) was eGFR (mL/min/1.73 m2) = 194 x Serum creatinine(-1.094) x Age(-0.287) x 0.739 (if female). In the validation data set, bias was -1.3 +/- 19.4 versus -5.9 +/- 19.0 mL/min/1.73 m2 (P = 0.002), and accuracy within 30% of mGFR was 73% versus 72% (P = 0.6) for equation 3 versus equation 1 and -2.1 +/- 19.0 versus -7.9 +/- 18.7 mL/min/1.73 m(2) (P < 0.001) and 75% versus 73% (P = 0.06) for equation 4 versus equation 2 (P = 0.06), respectively. Most study participants had chronic kidney disease, and some may have had changing GFRs. The new Japanese coefficient for the modified IDMS-MDRD Study equation and the new Japanese equation are more accurate for the Japanese population than the previously reported equations.
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              Universal definition of myocardial infarction.

              Kristian Thygesen, Joseph Alpert, Harvey White (2007)
              Article 0 comments Cited 350 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Takatoshi Kasai: kasai-t@mx6.nisiq.net
                Journal
                Journal ID (nlm-ta): BMC Cardiovasc Disord
                Journal ID (iso-abbrev): BMC Cardiovasc Disord
                Title: BMC Cardiovascular Disorders
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2261
                Publication date (Electronic): 15 January 2021
                Publication date PMC-release: 15 January 2021
                Publication date Collection: 2021
                Volume: 21
                Electronic Location Identifier: 36
                Affiliations
                [1 ]GRID grid.258269.2, ISNI 0000 0004 1762 2738, Department of Cardiovascular Medicine, , Juntendo University Graduate School of Medicine, ; 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
                [2 ]GRID grid.258269.2, ISNI 0000 0004 1762 2738, Cardiovascular Respiratory Sleep Medicine, , Juntendo University Graduate School of Medicine, ; 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
                [3 ]GRID grid.411966.d, Sleep and Sleep Disordered Breathing Center, , Juntendo University Hospital, ; 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
                [4 ]GRID grid.482667.9, Department of Cardiology, , Juntendo University Shizuoka Hospital, ; 1129 Nagaoka, Izunokuni, Shizuoka 410-2295 Japan
                Article
                Publisher ID: 1850
                DOI: 10.1186/s12872-021-01850-9
                PMC ID: 7809870
                PubMed ID: 33446110
                SO-VID: 7232c8c4-274d-40d3-a65b-e41b6d111374
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 12 November 2020
                Date accepted : 1 January 2021
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: beta-blocker,ischemic heart disease,mid-range ejection fraction,reduced ejection fraction
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: beta-blocker, ischemic heart disease, mid-range ejection fraction, reduced ejection fraction

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