Association of beta-blocker therapy at discharge with clinical outcomes in patients without heart failure or left ventricular systolic dysfunction after acute coronary syndrome: An updated systematic review and meta-analysis - 10/12/22
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Résumé |
In patients without heart failure or left ventricular systolic dysfunction after acute coronary syndrome in the contemporary percutaneous coronary intervention (PCI) era:
• | beta-blocker therapy may reduce the risk of all-cause death; |
• | no differences existed in other outcomes, which may be due to limited studies; |
• | beta-blocker may still be beneficial in the PCI era. |
Abstract |
Background |
Beta-blockers are the standard treatment for acute coronary syndrome (ACS) based on evidence from the prethrombolytic era.
We sought to examine the effect of beta-blocker treatment on patients without heart failure or left ventricular systolic dysfunction after ACS in the contemporary percutaneous coronary intervention (PCI) era.
Methods |
We systematically searched PubMed, Web of Science, Cochrane Library, ClinicalTrials.gov and Google Scholar for studies comparing beta-blockers versus no beta-blockers in ACS patients in the contemporary PCI era. The primary outcome was all-cause death. Pooling unadjusted and multivariable adjusted results were calculated under random-effects models.
Results |
Data from 15 studies (n=205,672), including 1 randomized trial, were analysed. Compared with no beta-blockers, beta-blocker therapy at discharge may reduce the risk of all-cause death (odds ratio [OR] 0.66, 95% confidence interval [CI]: 0.50–0.86; I2=81.9%). Subgroup analysis according to single or multicentre studies indicated similar results. Prospective studies suggested that all-cause death was less common in the beta-blocker group. After multivariable adjustment, a lower risk of all-cause death was still observed with beta-blockers (OR: 0.74, 95% CI: 0.59–0.94; I2=40.1%). No differences existed in major adverse cardiovascular events (MACE), cardiac death, myocardial infarction, heart failure, revascularization or stroke, before and after multivariable adjustment.
Conclusions |
In patients without heart failure or left ventricular systolic dysfunction after ACS in the contemporary PCI era, beta-blocker therapy may still be beneficial due to a potential reduced risk of all-cause death.
Le texte complet de cet article est disponible en PDF.Keywords : Acute coronary syndrome, Beta-blocker, Percutaneous coronary intervention, Heart failure, Left ventricular systolic dysfunction
Plan
Vol 115 - N° 12
P. 637-646 - décembre 2022 Retour au numéro
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