Long-Term Effect of Beta-Blockers on Mortality in Patients with Acute Myocardial Infarction Without Reduced Ejection Fraction in Phitsanulok
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Abstract
Currently, the American College of Cardiology/American Heart Association (ACC/AHA) and The European Society of Cardiology (ESC) guidelines remain unclear about the benefits of beta-blockers to reduce mortality among acute myocardial infarction (AMI) patients without reduced left ventricular ejection fraction (LVEF > 40%). Previous studies showed inconsistent results regarding the duration of benefits of using beta-blockers in AMI patients without reduced ejection fraction with LVEF > 40% to reduce major adverse cardiovascular events and mortality. Objective: This study aimed to assess the long-term effects of beta-blockers on mortality and major adverse cardiac events (MACE) in patients diagnosed with acute myocardial infarction without reduced left ventricular ejection fraction (LVEF > 40%). Method: This was a retrospective cohort study. Inclusion criteria were patients who had been firstly diagnosed with AMI and had LVEF > 40%, then they were divided into two groups including those prescribed beta-blockers at the time of discharge from hospital and those who were not. These two groups were followed up for 2 years. Data were obtained from the electronic medical record from Buddhachinaraj Hospital and Naresuan University Hospital. Cox proportional hazards model were used to estimate the effects of the primary outcome including death from any cause and MACE within 2 years after discharge. Results: A total of 473 patients with AMI and having LVEF > 40% were firstly diagnosed, 337 patients were prescribed with beta-blockers, 136 patients were not. It was shown that patients without beta-blockers had a higher rate of all-cause of death and MACE (8.8 percent) as compared to those with beta-blockers (7.4 percent). There were no statistically significant differences in all-cause death and MACE between the two groups observed (adjusted HR 0.62, 95%CI 0.31 to 1.24; p=0.172). Conclusion: Acute myocardial infarction patients without reduced left ventricular ejection fraction (LVEF > 40%) using beta-blockers and not using beta-blockers showed no significant differences in reducing all-cause of death and major adverse cardiac event.
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