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
N1 - Publisher Copyright:
© 2019, Japanese Circulation Society. All rights reserved.
PY - 2019
Y1 - 2019
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.
KW - Acute myocardial infarction
KW - Beta-blockers
KW - Heart rate
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U2 - 10.1253/circj.CJ-18-0995
DO - 10.1253/circj.CJ-18-0995
M3 - Article
C2 - 30930346
AN - SCOPUS:85065218967
SN - 1346-9843
VL - 83
SP - 1054
EP - 1063
JO - Circulation Journal
JF - Circulation Journal
IS - 5
ER -