Comparison of Early Versus Delayed Oral β Blockers in Acute Coronary Syndromes and Effect on Outcomes

Bugiardini, Raffaele and Cenko, Edina and Ricci, Beatrice and Vasiljevic, Zorana and Dorobantu, Maria and Kedev, Sasko and Vavlukis, Marija and Kalpak, Oliver and Puddu, Paolo Emilio and Gustiene, Olivija and Trninic, Dijana and Knezevic, Bozidarka and Milicic, Davor and Gale, Christopher P. and Manfrini, Olivia and Koller, Akos and Badimon, Lina (2016) Comparison of Early Versus Delayed Oral β Blockers in Acute Coronary Syndromes and Effect on Outcomes. The American Journal of Cardiology, 117 (5). pp. 760-767. ISSN 00029149

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ABSTRACT: The aim of this study was to determine if earlier administration of oral beta-blocker therapy in patients with acute coronary syndromes (ACSs) is associated with increased short-term survival and improved left ventricular (LV) function. We studied 11,581 patients enrolled in the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) 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 with unknown timing of oral beta-blocker administration was unknown and 182 because they had death 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 (≤24 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 [OR] 0.41, 95% confidence interval [CI] 0.21 to 0.80) and reduced incidence of severe LV dysfunction (OR 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 higher probability of improving LV function and in-hospital survival. Patients presenting with acute pulmonary edema or cardiogenic shock should be excluded from this early treatment regimen.

Item Type: Article
Subjects: Medical and Health Sciences > Clinical medicine
Divisions: Faculty of Medical Science
Depositing User: Marija Vavlukis
Date Deposited: 06 Dec 2016 13:09
Last Modified: 06 Dec 2016 13:09

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