Selection of β‐Blocker in Patients With Cirrhosis and Acute Myocardial Infarction: A 13‐Year Nationwide Population‐Based Study in Asia

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Shao‐Wei Chen¹  Pei‐Chi Ting²  Ming‐Shyan Lin³  Yu‐Sheng Lin³  Cheng‐Shyong Wu⁴  Chih‐Hsiang Chang⁵  Shang‐Hung Chang⁶  Ming‐Jer Hsieh⁶  Kuo‐Chun Hung⁶  I.‐Chang Hsieh⁶  Victor Chien‐Chia Wu⁶  Pao‐Hsien Chu⁶  Chao‐Yung Wang⁶  Michael Wu⁷ 

[1] Cardiothoracic and Vascular Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan;Department of Anesthesiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan;Department of Cardiology Chang Gung Memorial Hospital Chiayi Taiwan;Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital Chiayi Taiwan;Department of Nephrology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan;Division of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan;Divison of Cardiovascular Medicine Rhode Island Hospital Warren Alpert School of Medicine Brown University Providence RI;

关键词: acute myocardial infarction;    cirrhosis;    outcome;   

DOI  :  10.1161/JAHA.118.008982

来源: DOAJ

【 摘 要 】

Background It is not clear whether β1‐selective or nonselective β‐blockers should be used in patients with cirrhosis and acute myocardial infarction. Methods and Results Medical records were retrieved from Taiwan NHIRD (National Health Insurance Research Database) during 2001‐2013. Patients were excluded for age <20, previous acute myocardial infarction, contraindication to β‐blockers, chronic obstructive pulmonary disease, asthma, or atrioventricular conduction disease. Patients who died during index admission, had a follow‐up <6 months, had a medication ratio of either β1‐selective or nonselective β‐blocker <80%, or who switched between β‐blockers were also excluded. Patients on β1‐selective blockers and nonselective β‐blockers were propensity score matched and compared for outcome. Primary outcomes were 1‐ and 2‐year cardiovascular events, liver adverse outcomes, and all‐cause mortality. A total of 203 595 patients with acute myocardial infarction were enrolled, of whom 6355 had cirrhosis. After screening for exclusion criteria, 1769 patients (655 patients on β‐blockers and 1114 patients not on β‐blockers) were eligible for analysis. Among patients on β‐blockers, propensity score matching was performed, and 218 patients on β1‐selective blockers and 218 patients on nonselective β‐blockers were studied. During a 2‐year follow‐up, patients on β1‐selective blockers had significantly fewer major cardiac and cerebrovascular events (hazard ratio=0.62; 95% confidence interval=0.42‐0.91; P=0.014), a trend toward lower all‐cause mortality (hazard ratio=0.66; 95% confidence interval=0.38‐1.14; P=0.135), and nonworsening liver outcome (hazard ratio=0.66; 95% confidence interval=0.38‐1.14; P=0.354). Conclusions In patients with cirrhosis and acute myocardial infarction, selecting a β‐blocker is a clinical dilemma. Our study showed that the use of β1‐selective blockers is associated with lower risks of major cardiac and cerebrovascular events.

【 授权许可】

Unknown