Safety of Beta-Blocker Administration in STEMI Patients With Risk Factors for Cardiogenic Shock.

IF 0.8 Q4 PHARMACOLOGY & PHARMACY Hospital Pharmacy Pub Date : 2024-11-04 DOI:10.1177/00185787241295969
Nicole Castoro, Ashley E Woodruff, Lauren Lacoursiere, Kevin Mills, Maya R Chilbert
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Abstract

Beta-blockers are recommended in the first 24 hours after ST-segment elevation myocardial infarction (STEMI) except in those at risk of cardiogenic shock. This retrospective cohort study aimed to assess if early beta-blocker use was associated with cardiogenic shock development in STEMI patients. Cardiogenic shock was assessed in adult patients with STEMI undergoing percutaneous coronary intervention (PCI) with guideline defined risk factors for shock (age above 70 years, systolic blood pressure below 120 mmHg, and heart rate above 120 bpm or below 60 bpm) who did or did not receive a beta-blocker within 24 hours of PCI. Multivariable logistic regression was used to assess the association between cardiogenic shock development and early beta-blocker administration. A total of 216 patients were included, 85 with early beta-blocker administration and 131 without. Patients who received an early beta-blocker versus those who did not had a median (interquartile range) age of 63 (52-71) versus 66 (54-76; P = .2260) and peak troponin of 58.3 (15.0-132.4) ng/mL versus 51.6 (16.6-139.5; P = .9884). Cardiogenic shock occurred in 4.7% (n = 4) patients with early beta-blocker use versus 12.2% (n = 16; P = .0909) without. After backward stepwise logistic regression, early beta-blocker use was not associated with cardiogenic shock (adjusted odd ratio [aOR] 0.334, 95% confidence interval (CI) 0.106-1.047; P = .0599), but those with a peak troponin over 56 ng/mL had an over three-fold increased risk of developing cardiogenic shock (aOR 3.434, 95% CI 1.191-9.902; P = .0224) regardless of beta blocker administration. Early beta-blocker administration in STEMI patients may not be associated with shock development.

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对具有心源性休克风险因素的 STEMI 患者使用β-受体阻滞剂的安全性。
建议在 ST 段抬高型心肌梗死(STEMI)发生后的 24 小时内使用β-受体阻滞剂,有心源性休克风险的患者除外。这项回顾性队列研究旨在评估 STEMI 患者早期使用β-受体阻滞剂是否与心源性休克的发生有关。研究评估了接受经皮冠状动脉介入治疗(PCI)的 STEMI 成人患者的心源性休克情况,这些患者具有指南定义的休克风险因素(年龄大于 70 岁、收缩压低于 120 mmHg、心率高于 120 bpm 或低于 60 bpm),且在 PCI 术后 24 小时内接受或未接受β-受体阻滞剂治疗。多变量逻辑回归用于评估心源性休克的发生与早期使用β-受体阻滞剂之间的关系。共纳入了 216 例患者,其中 85 例接受了早期β-受体阻滞剂治疗,131 例未接受治疗。接受早期β-受体阻滞剂治疗的患者与未接受早期β-受体阻滞剂治疗的患者的中位(四分位间距)年龄分别为 63(52-71)岁与 66(54-76;P = .2260)岁,肌钙蛋白峰值分别为 58.3(15.0-132.4)纳克/毫升与 51.6(16.6-139.5;P = .9884)纳克/毫升。早期使用β受体阻滞剂的患者中发生心源性休克的比例为4.7%(n = 4),而未使用β受体阻滞剂的患者中发生心源性休克的比例为12.2%(n = 16;P = .0909)。经过后向逐步逻辑回归,早期使用β受体阻滞剂与心源性休克无关(调整后奇异比 [aOR] 0.334,95% 置信区间 (CI) 0.106-1.047;P = .0599),但肌钙蛋白峰值超过 56 纳克/毫升的患者发生心源性休克的风险增加了三倍多(aOR 3.434,95% CI 1.191-9.902;P = .0224),与是否使用β受体阻滞剂无关。STEMI 患者早期使用β受体阻滞剂可能与休克的发生无关。
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来源期刊
Hospital Pharmacy
Hospital Pharmacy PHARMACOLOGY & PHARMACY-
CiteScore
1.70
自引率
0.00%
发文量
63
期刊介绍: Hospital Pharmacy is a monthly peer-reviewed journal that is read by pharmacists and other providers practicing in the inpatient and outpatient setting within hospitals, long-term care facilities, home care, and other health-system settings The Hospital Pharmacy Assistant Editor, Michael R. Cohen, RPh, MS, DSc, FASHP, is author of a Medication Error Report Analysis and founder of The Institute for Safe Medication Practices (ISMP), a nonprofit organization that provides education about adverse drug events and their prevention.
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