Author + information
- Ibrahim El-Battrawy, MD∗ (, )
- Martin Borggrefe, MD and
- Ibrahim Akin, MD
- ↵∗First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
The paper by Dondo et al. (1) published in the Journal describing the effect of β-blockers among survivors of acute myocardial infarction within the MINAP (Myocardial Infarction National Audit Project) study elicited great interest among members of our research working group. The authors found no beneficial effect of β-blockers in patients with acute myocardial infarction without heart failure. In this regard, the authors defined heart failure as a history of heart failure, use of a loop diuretic on or during hospitalization, and/or a left ventricular ejection fraction <30% as recorded in the hospital.
The limitation of the MINAP study is that the final diagnosis of acute coronary syndrome (ACS) was based on the patient history or electrocardiographic or biochemical marker (2). We would like to bring the authors’ attention to the fact that Takotsubo syndrome mimics ACS and could not be distinguished by the overselected criteria at admission. However, the large International Takotsubo Registry reported a 5.6% mortality per patient year (3); the use of β-blockers did not affect the survival rate of these patients. The diagnosis of the culprit lesion was not required in the MINAP study and therefore it is possible that a high proportion of cases could be in fact reasonably be explained by Takotsubo syndrome. Consequently, more information about the coronary status is required before the final conclusion can be made regarding the absence of beneficial effects of β-blockers in ACS patients.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation