Comparison of Early Versus Delayed Oral beta Blockers in Acute Coronary Syndromes and Effect on Outcomes
Por:
Bugiardini, R, Cenko, E, Ricci, B, Vasiljevic, Z, Dorobantu, M, Kedev, S, Vavlukis, M, Kalpak, O, Puddu, PE, Gustiene, O, Trninic, D, Knezevic, B, Milicic, D, Gale, CP, Manfrini, O, Koller, A, Badimon, L
Publicada:
1 mar 2016
Resumen:
The aim of this study was to determine if earlier administration of oral blocker therapy in patients with acute coronary syndromes (ACSs) is associated with an increased short-term survival rate and improved left ventricular (LV) function. We studied 11,581 patients enrolled in the International Survey of Acute Coronary Syndromes in Transitional Countries registry from January 2010 to June 2014. Of these patients, 6,117 were excluded as they received intravenous beta blockers or remained free of any beta blocker treatment during hospital stay, 23 as timing of oral beta blocker administration was unknown, and 182 patients because they died before oral beta blockers could be given. The final study population comprised 5,259 patients. The primary outcome was the incidence of in-hospital mortality. The secondary outcome was the incidence of severe LV dysfunction defined as an ejection fraction <40% at hospital discharge. Oral beta blockers were administered soon (524 hours) after hospital admission in 1,377 patients and later (>24 hours) during hospital stay in the remaining 3,882 patients. Early beta blocker therapy was significantly associated with reduced in-hospital mortality (odds ratio 0.41, 95% CI 0:21 to 0.80) and reduced incidence of severe LV dysfunction (odds ratio 0.57, 95% CI 0.42 to 0.78). Significant mortality benefits with early beta blocker therapy disappeared when patients with Killip class III/IV were included as dummy variables. The results were confirmed by propensity score matched analyses. In conclusion, in patients with ACSs, earlier administration of oral beta blocker therapy should be a priority with a greater probability of improving LV function and in-hospital survival rate. Patients presenting with acute pulmonary edema or cardiogenic shock should be excluded from this early treatment regimen. (C) 2016 Elsevier Inc. All rights reserved.
Filiaciones:
Bugiardini, R:
Univ Bologna, Dept Expt Diagnost & Specialty Med, Bologna, Italy
Cenko, E:
Univ Bologna, Dept Expt Diagnost & Specialty Med, Bologna, Italy
Ricci, B:
Univ Bologna, Dept Expt Diagnost & Specialty Med, Bologna, Italy
Vasiljevic, Z:
Univ Belgrade, Fac Med, Clin Ctr Serbia, Belgrade, Serbia
Dorobantu, M:
Floreasca Emergency Hosp, Dept Internal Med & Cardiol, Bucharest, Romania
Kedev, S:
Univ St Cyril & Methudius, Fac Med, Univ Clin Cardiol, Skopje 91000, Macedonia
Vavlukis, M:
Univ St Cyril & Methudius, Fac Med, Univ Clin Cardiol, Skopje 91000, Macedonia
Kalpak, O:
Univ St Cyril & Methudius, Fac Med, Univ Clin Cardiol, Skopje 91000, Macedonia
Puddu, PE:
Univ Roma La Sapienza, Dept Cardiovasc Resp Nephrol Anesthesiol & Geriat, Piazzale Aldo Moro 5, I-00185 Rome, Italy
Gustiene, O:
Lithuanian Univ Hlth Sci, Dept Cardiol, Kaunas, Lithuania
Trninic, D:
Univ Clin Ctr Republ Srpska, Clin Cardiovasc Dis, Banja Luka, Republika Srpsk, Bosnia & Herceg
Knezevic, B:
Clin Ctr Montenegro, Ctr Cardiol, Podgorica, Montenegro
Milicic, D:
Univ Zagreb, Univ Hosp Ctr Zagreb, Dept Cardiovasc Dis, Zagreb 41000, Croatia
Gale, CP:
Univ Leeds, Div Epidemiol & Biostat, Leeds, W Yorkshire, England
York Teaching Hosp NHS Fdn Trust, York, N Yorkshire, England
Manfrini, O:
Univ Bologna, Dept Expt Diagnost & Specialty Med, Bologna, Italy
Koller, A:
Univ Phys Educ, Inst Nat Sci, Budapest, Hungary
New York Med Coll, Dept Physiol, Valhalla, NY 10595 USA
Badimon, L:
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, CSIC ICCC, Cardiovasc Res Ctr, Barcelona, Spain
Green Accepted
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