Circulation Journal, 2019. 83(2), 410-417, DOI: https://doi.org/10.1253/circj.CJ-18-0662

Prognostic Impact of β-Blocker Dose After Acute Myocardial Infarction

Doyeon Hwang, Joo Myung Lee;Hyun Kuk Kim;Ki Hong Choi;Tae-Min Rhee;Jonghanne Park;Taek Kyu Park;Jeong Hoon Yang;Young Bin Song;Jin-Ho Choi;Joo-Yong Hahn;Seung-Hyuk Choi;Bon-Kwon Koo;Young Jo Kim;Shung-Chull Chae;Myeong Chan Cho;Chong Jin Kim;Hyeon-Cheol Gwon;Myung Ho Jeong;Hyo-Soo Kim;The KAMIR Investigators

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.

• DOI: https://doi.org/10.1253/circj.CJ-18-0662
• ISBN or ISSN: 1346-9843

• 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.