Safety of beta-blocker discontinuation after acute coronary syndromes with preserved or mildly reduced left ventricular ejection fraction: a target trial emulation from a real-world cohort.

IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European journal of preventive cardiology Pub Date : 2024-10-26 DOI:10.1093/eurjpc/zwae346
Nicolas Johner, Mattia Branca, David Carballo, Stéphanie Baggio, David Nanchen, Elena Tessitore, Lorenz Räber, Thomas Felix Lüscher, Christian M Matter, Stephan Windecker, Nicolas Rodondi, François Mach, Baris Gencer
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Abstract

Aims: The benefit of long-term beta-blocker therapy after acute coronary syndromes (ACS) without heart failure in the reperfusion era is uncertain. Two recent randomized trials found conflicting results. The present study assessed the safety of beta-blocker discontinuation within 12 months following ACS with LVEF ≥40%.

Methods: In a multicentre prospective real-world cohort (N=3,762) of patients hospitalized for ACS, patients with LVEF ≥40% and beta-blockers at discharge were included. Patients who continued beta-blockers at one year were compared with those who discontinued beta-blockers within 12 months post-ACS using target trial emulation and inverse probability weighting over an additional four-year follow-up. The primary endpoint was major adverse cardiovascular events (MACE), a composite of four-year cardiovascular death, myocardial infarction, stroke, transient ischemic attack, unplanned coronary revascularization, or unstable angina hospitalization.

Results: Of 2,077 patients, 1,758 (85%) continued beta-blockers and 319 (15%) had discontinued beta-blockers at one year. The risk of primary endpoint was similar in both groups (14.1% versus 14.3% with beta-blocker discontinuation versus continuation; adjusted hazard ratio [aHR]=0.98; 95% confidence interval, 0.72-1.34, P=0.91). Subgroup analysis suggested a higher risk of primary endpoint with beta-blocker discontinuation after STEMI (aHR=1.46 [0.99-2.16]) compared to NSTEMI (aHR=0.70 [0.40-1.22], Pinteraction=0.033), whereas there was no interaction with LVEF (Pinteraction=0.68).

Conclusions: Beta-blocker discontinuation within 12 months following ACS with LVEF ≥40% was not associated with an increased risk of MACE compared to long-term beta-blocker therapy. Subgroup analysis suggested potential risk in STEMI patients. Discontinuing beta-blockers 12 months after ACS appears safe in patients with LVEF ≥40%, particularly after NSTEMI.

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左心室射血分数保留或轻度降低的急性冠状动脉综合征后停用β-受体阻滞剂的安全性:来自真实世界队列的目标试验模拟。
目的:在再灌注时代,急性冠状动脉综合征(ACS)后无心力衰竭者长期接受β-受体阻滞剂治疗的益处尚不确定。最近的两项随机试验发现了相互矛盾的结果。本研究评估了LVEF≥40%的急性冠状动脉综合征后12个月内停用β-受体阻滞剂的安全性:在一项多中心前瞻性真实世界队列(N=3,762)中,纳入了因 ACS 住院的 LVEF ≥40% 且出院时服用过β-受体阻滞剂的患者。在为期四年的随访中,采用目标试验仿真和反概率加权法,将在一年后继续使用β-受体阻滞剂的患者与在ACS后12个月内停用β-受体阻滞剂的患者进行比较。主要终点是主要不良心血管事件(MACE),即四年内心血管死亡、心肌梗死、中风、短暂性脑缺血发作、非计划性冠状动脉血运重建或不稳定型心绞痛住院的综合结果:在2077名患者中,有1758人(85%)继续服用β-受体阻滞剂,319人(15%)在一年后停用了β-受体阻滞剂。两组患者的主要终点风险相似(停用β-受体阻滞剂与继续使用β-受体阻滞剂的风险分别为14.1%和14.3%;调整后危险比[aHR]=0.98;95%置信区间为0.72-1.34,P=0.91)。亚组分析表明,与NSTEMI(aHR=0.70 [0.40-1.22],Pinteraction=0.033)相比,STEMI(aHR=1.46 [0.99-2.16])后停用β受体阻滞剂的主要终点风险更高,而与LVEF(Pinteraction=0.68)无交互作用:与长期β-受体阻滞剂治疗相比,LVEF≥40%的ACS患者在12个月内停用β-受体阻滞剂与MACE风险增加无关。亚组分析表明 STEMI 患者存在潜在风险。对于 LVEF ≥40% 的患者,尤其是 NSTEMI 患者,在 ACS 后 12 个月停用β-受体阻滞剂似乎是安全的。
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来源期刊
European journal of preventive cardiology
European journal of preventive cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
12.50
自引率
12.00%
发文量
601
审稿时长
3-8 weeks
期刊介绍: European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.
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