| Related Articles |
Selection of β-Blocker in Patients With Cirrhosis and Acute Myocardial Infarction: A 13-Year Nationwide Population-Based Study in Asia.
J Am Heart Assoc. 2018 Oct 02;7(19):e008982
Authors: Wu VC, Chen SW, Ting PC, Chang CH, Wu M, Lin MS, Hsieh MJ, Wang CY, Chang SH, Hung KC, Hsieh IC, Chu PH, Wu CS, Lin YS
Abstract
Background It is not clear whether β1-selective or nonselective β-blockers should be used in patients with cirrhosis and acute myocardial infarction. Methods and Results Medical records were retrieved from Taiwan NHIRD (National Health Insurance Research Database) during 2001-2013. Patients were excluded for age <20, previous acute myocardial infarction, contraindication to β-blockers, chronic obstructive pulmonary disease, asthma, or atrioventricular conduction disease. Patients who died during index admission, had a follow-up <6 months, had a medication ratio of either β1-selective or nonselective β-blocker <80%, or who switched between β-blockers were also excluded. Patients on β1-selective blockers and nonselective β-blockers were propensity score matched and compared for outcome. Primary outcomes were 1- and 2-year cardiovascular events, liver adverse outcomes, and all-cause mortality. A total of 203 595 patients with acute myocardial infarction were enrolled, of whom 6355 had cirrhosis. After screening for exclusion criteria, 1769 patients (655 patients on β-blockers and 1114 patients not on β-blockers) were eligible for analysis. Among patients on β-blockers, propensity score matching was performed, and 218 patients on β1-selective blockers and 218 patients on nonselective β-blockers were studied. During a 2-year follow-up, patients on β1-selective blockers had significantly fewer major cardiac and cerebrovascular events (hazard ratio=0.62; 95% confidence interval=0.42-0.91; P=0.014), a trend toward lower all-cause mortality (hazard ratio=0.66; 95% confidence interval=0.38-1.14; P=0.135), and nonworsening liver outcome (hazard ratio=0.66; 95% confidence interval=0.38-1.14; P=0.354). Conclusions In patients with cirrhosis and acute myocardial infarction, selecting a β-blocker is a clinical dilemma. Our study showed that the use of β1-selective blockers is associated with lower risks of major cardiac and cerebrovascular events.
PMID: 30371327 [PubMed - in process]