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Background: The benefit of beta-blockers in the management of patients with heart failure and left ventricular systolic dysfunction is established; however, their role in patients whose post-MI course is without such complications, recurrent ischemia, or arrhythmia is less established. We investigated the association between beta-blocker use and all-cause mortality in patients presenting with acute coronary syndrome (ACS) according to the presence versus absence of significant LV ejection fraction (LVEF).
Methods: 2181 patients with ACS (age 58.5 ± 13.74years) who underwent invasive coronary angiography and cardiac magnetic resonance (CMR) imaging (mean interval 1.0±1.5 months) were studied. The latter was used to determine LV volumes, mass, and LVEF. Patients were stratified by presence of moderate-severe LV dysfunction, defined as LVEF ≤40%.
Results: Corresponding CMR characteristics for patient with (N=467) versus without (N=1714) significant LV dysfunction were as follows; LVEF: 53.7± 9.9% vs 24.5±6.5% (p<0.01), mean LVEDVI: 91.0±25.1 ml/m2 vs 150.8±45.2 ml/m2 (p<0.01), and mean LVMI: 72.8 ± 23.5 g/m2 vs 93.8±28.7 g/m2 (p<0.01). Over a median follow-up of 2.8 years (IQR 0.7 to 5.0) 179 patients died (80 in LV dysfunction group). In multivariate analysis, inclusive of medical co-morbidities, extent of coronary artery disease, and other medication use, those with LV dysfunction showed beta blocker use post ACS to be associated with a 40% reduction in all-cause mortality (HR 0.60, 95% CI 0.36 – 0.98, p=0.04). However, in patients with preserved LVEF a significant increase in all-cause mortality was identified (adjusted HR 1.65, 95% CI 1.02-2.71, p=0.04).
Conclusions: In this cohort, beta blocker use in patients with preserved LV function post ACS was unexpectedly associated with an increase in all-cause mortality following adjustment for important baseline covariates. These findings warrant investigation into the value and appropriateness of beta blocker therapy in patients with preserved LV function following ACS.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Updates in Stable Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1125-303
- 2017 American College of Cardiology Foundation