TY - JOUR
T1 - Selection of β‐blocker in patients with cirrhosis and acute myocardial infarction
T2 - A 13‐year nationwide population‐based study in Asia
AU - Wu, Victor Chien Chia
AU - Chen, Shao Wei
AU - Ting, Pei Chi
AU - Chang, Chih Hsiang
AU - Wu, Michael
AU - Lin, Ming Shyan
AU - Hsieh, Ming Jer
AU - Wang, Chao Yung
AU - Chang, Shang Hung
AU - Hung, Kuo Chun
AU - Hsieh, I. Chang
AU - Chu, Pao Hsien
AU - Wu, Cheng Shyong
AU - Lin, Yu Sheng
N1 - Publisher Copyright:
© 2018 The Authors.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background-—It is not clear whether b1-selective or nonselective b-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 b-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 b1-selective or nonselective b-blocker <80%, or who switched between bblockers were also excluded. Patients on b1-selective blockers and nonselective b-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 b-blockers and 1114 patients not on b-blockers) were eligible for analysis. Among patients on b-blockers, propensity score matching was performed, and 218 patients on b1-selective blockers and 218 patients on nonselective b-blockers were studied. During a 2-year follow-up, patients on b1-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 b-blocker is a clinical dilemma. Our study showed that the use of b1-selective blockers is associated with lower risks of major cardiac and cerebrovascular events.
AB - Background-—It is not clear whether b1-selective or nonselective b-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 b-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 b1-selective or nonselective b-blocker <80%, or who switched between bblockers were also excluded. Patients on b1-selective blockers and nonselective b-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 b-blockers and 1114 patients not on b-blockers) were eligible for analysis. Among patients on b-blockers, propensity score matching was performed, and 218 patients on b1-selective blockers and 218 patients on nonselective b-blockers were studied. During a 2-year follow-up, patients on b1-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 b-blocker is a clinical dilemma. Our study showed that the use of b1-selective blockers is associated with lower risks of major cardiac and cerebrovascular events.
KW - Acute myocardial infarction
KW - Cirrhosis
KW - Outcome
UR - https://www.scopus.com/pages/publications/85055614131
U2 - 10.1161/JAHA.117.008982
DO - 10.1161/JAHA.117.008982
M3 - 文章
C2 - 30371327
AN - SCOPUS:85055614131
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 19
M1 - e008982
ER -
