Benefit of Vasodilating β‐Blockers in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: Nationwide Multicenter Cohort Study

Objectives: Patients surviving an acute myocardial infarction (AMI) are different today than when oral β-blockers first were shown to have an incremental effect on mortality. They are now, as opposed to then, offered revascularization procedures and effective secondary prevention. In this pilot-study, we aimed to explore the prescription of β-blockers to these patients stratified by their left ventricular ejection fraction (LVEF). Methods: Consecutive stable patients treated with a percutaneous coronary intervention (PCI) procedure following an AMI were included for measurement of LVEF after 1–5 days. β-Blocker treatment was recorded at inclusion and after 3 months. Results: We included 159 patients, 89% with LVEF ≥40% (56% had a LVEF ≥50% [preserved], 33% LVEF 40–49% [mid-range] and 11% LVEF <40% [reduced]). At discharge the prescription rates of β-blockers according to LVEF stratification were 79% for preserved, 79% for mid-range and 94% for reduced LVEF. After 3 months 72% of all patients continued such treatment. Conclusions: In this prospective study, a large proportion of contemporary managed patients with AMI but without clinical heart failure does not have reduced LVEF shortly after PCI, but the majority is still treated with a β-blocker.

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In-hospital cardiac rehabilitation and clinical outcomes in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-039096 ◽

2020 ◽

Vol 10 (9) ◽

pp. e039096

Author(s):

Natsuko Kanazawa ◽

Hiroaki Iijima ◽

Kiyohide Fushimi

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Cohort Study ◽

Retrospective Cohort ◽

Coronary Intervention ◽

Cardiac Mortality ◽

Percutaneous Coronary ◽

All Cause Mortality

ObjectivesTo verify the associations between participation in an in-hospital cardiac rehabilitation (CR) programme and clinical outcomes among patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).DesignA retrospective cohort study using the Japanese administrative claims database.SettingJapanese acute-care hospitals.ParticipantsPatients aged ≥18 years who underwent PCI due to AMI and survived to discharge.Primary and secondary outcome measureThe primary outcomes were revascularisation, all-cause readmission and cardiac readmission (median follow-up period: 324 days, 236 days and 263 days, respectively). The secondary outcomes were all-cause mortality and cardiac mortality (median follow-up period: both were 460 days).ResultThe data of 13 697 patients were extracted from the database, and 65.4% of them participated in an in-hospital CR. The risks of revascularisation, all-cause readmission and cardiac readmission among CR participants were compared with those of non-participants using two statistical techniques: matched-pair analysis based on propensity score and a 30-day landmark analysis. The results of those analysis were consistent and showed that the CR participants had lower risk of revascularisation (adjusted HR: 0.74; 95% CI: 0.65 to 0.84), all-cause readmission (HR: 0.81; 95% CI: 0.74 to 0.88) and cardiac readmission (HR: 0.77; 95% CI: 0.70 to 0.85). However, all-cause mortality and cardiac mortality were not associated with participation in the CR.ConclusionsIt was suggested that in-hospital CR participation may reduce the risk of revascularisation, all-cause readmission and cardiac readmission among patients with AMI after PCI. In-hospital CR may expand the potential benefits of CR in addition to outpatient CR.

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