Comparative effects of three beta blockers (atenolol, metoprolol, and propranolol) on survival after acute myocardial infarction∗∗The views expressed in this article do not necessarily reflect the official position of the Health Care Financing Administration.

BACKGROUND Studies of hospital quality and national performance measures for acute myocardial infarction (AMI) frequently exclude transfer patients. Little is known about the clinical characteristics and outcomes of patients with AMI transferred for revascularization. HYPOTHESIS Transfer patients have greater clinical comorbidity and worse hospital survival than non-transfer patients, and negatively impact hospital quality measures. METHODS A retrospective-cohort study was performed using all patients with ST-elevation myocardial infarction who underwent coronary intervention or coronary artery bypass grafting (CABG) in Washington State from 2002 – 2005. Data on clinical and procedural characteristics, medications, and complications were obtained from the Clinical Outcomes Assessment Program. Hospitals were compared by rates of death and discharge with aspirin, beta-blockers, lipid lowering agents, and ACE inhibitors. Logistic regression was used for adjusted analysis. RESULTS Of patients undergoing revascularization for AMI, 7080 were directly admitted and 2910 were transferred. Diabetes (23.4 v. 19.7%, p<0.01), hypertension (61.3 v. 55.7%, p<0.01), and thrombolysis (32.3 v. 3.4%, p <0.01) were greater among transfers. Transfers presented with a higher rate of left main and three-vessel disease, intra-aortic balloon pump use (6.4 v. 3.6%, p<0.01) and underwent CABG more frequently (15.4 v. 5.5%, p <0.01). Transfer patients had a lower risk of death (3.9 v. 4.9%, p=0.03), but no difference in discharge medication prescription. Adjusting for major risk factors, procedure, and hospital type, transfers had a similar risk for in-hospital death compared to non-transfers (OR 0.9, CI 0.5 – 1.6). Hospitals with a high percentage of transfers treated higher-risk patients, but had similar outcomes to those with few transfers. Excluding transfers from the hospital-level analysis did not appreciably change these results. CONCLUSION Transfers were higher-risk, but had similar in-hospital mortality and were equally likely to receive appropriate medication at discharge compared to directly admitted patients. Inclusion of transfers did not affect hospital-level inpatient mortality or measurements of adherence to quality guidelines.

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Abstract 12691: Long-term Optimal Medical Therapy for Patients With Mid-range Left Ventricular Ejection Fraction After Acute Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.12691 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

YeeKyoung KO ◽

Seungjae JOO ◽

Jong Wook Beom ◽

Jae-Geun Lee ◽

Joon-Hyouk CHOI ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Left Ventricular Ejection Fraction ◽

Medical Therapy ◽

Beta Blockers ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Ras Inhibitors

Introduction: In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mid-range left ventricular ejection fraction (40% <EF<50%) becomes increasing. However, the long-term optimal medical therapy for these patients has been rarely studied. Aims: This observational study aimed to investigate the association between the medical therapy with beta-blockers or inhibitors of renin-angiotensin system (RAS) and clinical outcomes in patients with mid-range EF after AMI. Methods: Among 13,624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), propensity-score matched patients who survived the initial attack and had mid-range EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Results: Patients with beta-blockers showed significantly lower 1-year cardiac death (2.4 vs. 5.2/100 patient-year; hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.22-0.98; P =0.045) and MI (1.7 vs. 4.0/100 patient-year; HR 0.41; 95% CI 0.18-0.95; P =0.037). On the other hand, RAS inhibitors were associated with lower 1-year re-hospitalization due to heart failure (2.8 vs. 5.5/100 patient-year; HR 0.54; 95% CI 0.31-0.92; P =0.024), and no significant interaction with classes of RAS inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) was observed ( P for interaction=0.332). Conclusions: Beta-blockers or RAS inhibitors at discharge were associated with better 1-year clinical outcomes in patients with mid-range EF after AMI.

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4055Should we use beta-blockers in all patients after st-segment elevation acute myocardial infarction?

European Heart Journal ◽

10.1093/eurheartj/ehy563.4055 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

J Ferreira ◽

F Freitas ◽

C Ferreira ◽

J Milner ◽

P Alves ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Beta Blockers ◽

St Segment Elevation ◽

St Segment ◽

Elevation Acute Myocardial Infarction

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P6424The association between long-term beta-blocker use and outcome in a contemporary large-scale cohort of patients with acute myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz746.1018 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C X Song ◽

R Fu ◽

J G Yang ◽

K F Dou ◽

Y J Yang

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Beta Blocker ◽

Cardiovascular Events ◽

Beta Blockers ◽

Left Ventricular Ejection ◽

Major Adverse Cardiovascular Events ◽

Baseline Characteristics

Abstract Background Controversy exists regarding the use of beta-blockers (BBs) among patients with acute myocardial infarction (AMI) in contemporary reperfusion era. Previous studies predominantly focused on beta-blockers prescribed at discharge, and the effect of long-term adherence to beta-blocker on major adverse cardiovascular events (MACE) remains unclear. Objective To explore the association between long-term beta-blocker use patterns and MACE among contemporary AMI patients. Methods We enrolled 7860 patients with AMI, who were discharged alive and prescribed with BBs based on CAMI registry from January 2013 to September 2014. Patients were divided into two groups according to BBs use pattern: Always users group (n=4476) were defined as patients reporting BBs use at both 6- and 12-month follow-up; Inconsistent users group were defined as patients reporting at least once not using BBs at 6- or 12-month follow-up. Primary outcome was defined as MACE at 24-month follow-up, including all-cause death, non-fatal MI and repeat-revascularization. Multivariable cox proportional hazards regression model was used to assess the association between BBs and MACE. Results Baseline characteristics are shown in table 1. At 2-year follow-up, 518 patients in inconsistent users group (15.6%) and 548 patients in always users group (12.3%) had MACE. After multivariable adjustment, inconsistent use of BBs was associated with higher risk of MACE (HR: 1.323, 95% CI: 1.171–1.493, p<0.001). Table 1 Baseline characteristics Variable Always user (N=4476) Inconsistent user (N=3384) P value Age (years) 60.6±12.0 61.2±12.2 <0.001 Male 3381 (75.7%) 2461 (74.3%) 0.084 Diabetes 892 (20.0%) 610 (18.4%) 0.003 Hypertension 2372 (53.2%) 1543 (46.6%) <0.001 Dyslipidemia 244 (5.5%) 126 (3.8%) <0.001 Prior myocardial infarction 351 (7.9%) 232 (7.0%) <0.001 Heart failure 88 (2.0%) 63 (1.9%) <0.001 Chronic obstructive pulmonary disease 66 (1.5%) 60 (1.8%) <0.001 Current smoker 2054 (46.1%) 1579 (47.8%) 0.179 Left ventricular ejection fraction (%) 53.7±11.48 54.0±10.9 <0.001 Major Adverse Cardiovascular Events 548 (12.3%) 518 (15.6%) <0.001 Conclusions Our results showed consistent BBs use was associated with reduced risk of MACE among patients with AMI managed by contemporary treatment. Acknowledgement/Funding CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)

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Early, Subacute Coronary Stent Thrombosis: A Complication of COVID-19 Infection

Dubai Medical Journal ◽

10.1159/000520461 ◽

2021 ◽

pp. 1-4

Author(s):

Sadeq Tabatabai ◽

Nooshin Bazargani ◽

Kamaleldin Al-Tahmody ◽

Jasem Mohammed Alhashmi

Keyword(s):

Myocardial Infarction ◽

Health Care ◽

Acute Myocardial Infarction ◽

Stent Thrombosis ◽

Coronary Angioplasty ◽

Anterior Wall ◽

Coronary Stent ◽

Antithrombotic Agents ◽

Health Care Burden ◽

Primary Coronary Angioplasty

Soon after it was discovered in Wuhan, China, in December 2019, coronavirus disease 2019 (COVID-19) blow-out very fast and became a pandemic. The usual presentation is respiratory tract infection, but cardiovascular system involvement is sometimes fatal and also a serious personal and health care burden. We report a case of a 57-year-old man who was admitted with anterior wall acute myocardial infarction secondary to early coronary stent thrombosis and associated with COVID-19 infection. He was managed with primary coronary angioplasty and discharged home. Procoagulant and hypercoagulability status associated with severe acute respiratory syndrome coronavirus 2 infection is the most likely culprit. Choosing aggressive antithrombotic agents after coronary angioplasty to prevent stent thrombosis during the COVID-19 pandemic may be the answer but could be challenging.

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