Admission heart rate is a determinant of effectiveness of beta-blockers in acute myocardial infarction patients

on behalf of J-MINUET Investigators

Research output: Contribution to journalArticle

Abstract

Background: Beta-blockers are standard therapy for acute myocardial infarction (AMI). However, despite current advances in the management of AMI, it remains unclear whether all AMI patients benefit from β-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of β-blockers for AMI patients. Methods and Results: We enrolled 3,283 consecutive AMI patients who were admitted to 28 participating institutions in the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) study. According to admission HR, we divided patients into 3 groups: bradycardia (HR <60 beats/min, n=444), normocardia (HR 60 to ≤100 beats/min, n=2,013), and tachycardia (HR >100 beats/min, n=342). The primary endpoint was major adverse cardiac events (MACE), including all-cause death, non-fatal MI, non-fatal stroke, heart failure (HF), and urgent revascularization for unstable angina, at 3-year follow-up. Beta-blocker at discharge was significantly associated with a lower risk of MACE in the tachycardia group (23.6% vs. 33.0%; P=0.033), but it did not affect rates of MACE in the normocardia group (17.8% vs. 18.4%; P=0.681). In the bradycardia group, β-blocker use at discharge was significantly associated with a higher risk of MACE (21.6% vs. 12.7%; P=0.026). Results were consistent for multivariable regression and stepwise multivariable regression. Conclusions: Admission HR might determine the efficacy of β-blockers for current AMI patients.

Original languageEnglish
Pages (from-to)1054-1063
Number of pages10
JournalCirculation Journal
Volume83
Issue number5
DOIs
Publication statusPublished - 01-01-2019

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Heart Rate
Myocardial Infarction
Bradycardia
Unstable Angina
Tachycardia
Registries
Cause of Death
Heart Failure
Stroke

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{d8701dd9e5ed4f21933a5db73bea1a23,
title = "Admission heart rate is a determinant of effectiveness of beta-blockers in acute myocardial infarction patients",
abstract = "Background: Beta-blockers are standard therapy for acute myocardial infarction (AMI). However, despite current advances in the management of AMI, it remains unclear whether all AMI patients benefit from β-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of β-blockers for AMI patients. Methods and Results: We enrolled 3,283 consecutive AMI patients who were admitted to 28 participating institutions in the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) study. According to admission HR, we divided patients into 3 groups: bradycardia (HR <60 beats/min, n=444), normocardia (HR 60 to ≤100 beats/min, n=2,013), and tachycardia (HR >100 beats/min, n=342). The primary endpoint was major adverse cardiac events (MACE), including all-cause death, non-fatal MI, non-fatal stroke, heart failure (HF), and urgent revascularization for unstable angina, at 3-year follow-up. Beta-blocker at discharge was significantly associated with a lower risk of MACE in the tachycardia group (23.6{\%} vs. 33.0{\%}; P=0.033), but it did not affect rates of MACE in the normocardia group (17.8{\%} vs. 18.4{\%}; P=0.681). In the bradycardia group, β-blocker use at discharge was significantly associated with a higher risk of MACE (21.6{\%} vs. 12.7{\%}; P=0.026). Results were consistent for multivariable regression and stepwise multivariable regression. Conclusions: Admission HR might determine the efficacy of β-blockers for current AMI patients.",
author = "{on behalf of J-MINUET Investigators} and Taishi Okuno and Jiro Aoki and Kengo Tanabe and Koichi Nakao and Yukio Ozaki and Kazuo Kimura and Junya Ako and Teruo Noguchi and Satoshi Yasuda and Satoru Suwa and Kazuteru Fujimoto and Yasuharu Nakama and Takashi Morita and Wataru Shimizu and Yoshihiko Saito and Atsushi Hirohata and Yasuhiro Morita and Teruo Inoue and Atsunori Okamura and Toshiaki Mano and Kazuhito Hirata and Yoshisato Shibata and Mafumi Owa and Kenichi Tsujita and Hiroshi Funayama and Nobuaki Kokubu and Ken Kozuma and Shiro Uemura and Tetsuya Tobaru and Keijiro Saku and Shigeru Ohshima and Kunihiro Nishimura and Yoshihiro Miyamoto and Hisao Ogawa and Masaharu Ishihara",
year = "2019",
month = "1",
day = "1",
doi = "10.1253/circj.CJ-18-0995",
language = "English",
volume = "83",
pages = "1054--1063",
journal = "Circulation Journal",
issn = "1346-9843",
publisher = "Japanese Circulation Society",
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}

Admission heart rate is a determinant of effectiveness of beta-blockers in acute myocardial infarction patients. / on behalf of J-MINUET Investigators.

In: Circulation Journal, Vol. 83, No. 5, 01.01.2019, p. 1054-1063.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Admission heart rate is a determinant of effectiveness of beta-blockers in acute myocardial infarction patients

AU - on behalf of J-MINUET Investigators

AU - Okuno, Taishi

AU - Aoki, Jiro

AU - Tanabe, Kengo

AU - Nakao, Koichi

AU - Ozaki, Yukio

AU - Kimura, Kazuo

AU - Ako, Junya

AU - Noguchi, Teruo

AU - Yasuda, Satoshi

AU - Suwa, Satoru

AU - Fujimoto, Kazuteru

AU - Nakama, Yasuharu

AU - Morita, Takashi

AU - Shimizu, Wataru

AU - Saito, Yoshihiko

AU - Hirohata, Atsushi

AU - Morita, Yasuhiro

AU - Inoue, Teruo

AU - Okamura, Atsunori

AU - Mano, Toshiaki

AU - Hirata, Kazuhito

AU - Shibata, Yoshisato

AU - Owa, Mafumi

AU - Tsujita, Kenichi

AU - Funayama, Hiroshi

AU - Kokubu, Nobuaki

AU - Kozuma, Ken

AU - Uemura, Shiro

AU - Tobaru, Tetsuya

AU - Saku, Keijiro

AU - Ohshima, Shigeru

AU - Nishimura, Kunihiro

AU - Miyamoto, Yoshihiro

AU - Ogawa, Hisao

AU - Ishihara, Masaharu

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Beta-blockers are standard therapy for acute myocardial infarction (AMI). However, despite current advances in the management of AMI, it remains unclear whether all AMI patients benefit from β-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of β-blockers for AMI patients. Methods and Results: We enrolled 3,283 consecutive AMI patients who were admitted to 28 participating institutions in the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) study. According to admission HR, we divided patients into 3 groups: bradycardia (HR <60 beats/min, n=444), normocardia (HR 60 to ≤100 beats/min, n=2,013), and tachycardia (HR >100 beats/min, n=342). The primary endpoint was major adverse cardiac events (MACE), including all-cause death, non-fatal MI, non-fatal stroke, heart failure (HF), and urgent revascularization for unstable angina, at 3-year follow-up. Beta-blocker at discharge was significantly associated with a lower risk of MACE in the tachycardia group (23.6% vs. 33.0%; P=0.033), but it did not affect rates of MACE in the normocardia group (17.8% vs. 18.4%; P=0.681). In the bradycardia group, β-blocker use at discharge was significantly associated with a higher risk of MACE (21.6% vs. 12.7%; P=0.026). Results were consistent for multivariable regression and stepwise multivariable regression. Conclusions: Admission HR might determine the efficacy of β-blockers for current AMI patients.

AB - Background: Beta-blockers are standard therapy for acute myocardial infarction (AMI). However, despite current advances in the management of AMI, it remains unclear whether all AMI patients benefit from β-blockers. We investigated whether admission heart rate (HR) is a determinant of the effectiveness of β-blockers for AMI patients. Methods and Results: We enrolled 3,283 consecutive AMI patients who were admitted to 28 participating institutions in the Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) study. According to admission HR, we divided patients into 3 groups: bradycardia (HR <60 beats/min, n=444), normocardia (HR 60 to ≤100 beats/min, n=2,013), and tachycardia (HR >100 beats/min, n=342). The primary endpoint was major adverse cardiac events (MACE), including all-cause death, non-fatal MI, non-fatal stroke, heart failure (HF), and urgent revascularization for unstable angina, at 3-year follow-up. Beta-blocker at discharge was significantly associated with a lower risk of MACE in the tachycardia group (23.6% vs. 33.0%; P=0.033), but it did not affect rates of MACE in the normocardia group (17.8% vs. 18.4%; P=0.681). In the bradycardia group, β-blocker use at discharge was significantly associated with a higher risk of MACE (21.6% vs. 12.7%; P=0.026). Results were consistent for multivariable regression and stepwise multivariable regression. Conclusions: Admission HR might determine the efficacy of β-blockers for current AMI patients.

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U2 - 10.1253/circj.CJ-18-0995

DO - 10.1253/circj.CJ-18-0995

M3 - Article

VL - 83

SP - 1054

EP - 1063

JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

IS - 5

ER -