β阻断剂对无心肌梗死或充血性心衰病史的冠状动脉疾病患者的死亡率和未来心肌梗死发生率的影响

作     者：Bunch T. J. Muhlestein J. B. Bair T. L. 刘健 

作者机构：Dr. Cardiovascular Department LDS Hospital 8th Avenue and C Street Salt Lake CityUT 84143United States 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第9期

页      面：30-31页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：充血性心衰 β阻断剂 非致死性 联合终点 全因死亡 他汀类药物 血管造影 使用指征 

摘      要：Beta-blocker therapy has been shown to benefit patients who have coronary artery disease and present with acute myocardial infarction(AMI) and/or congestive heart failure(HF). However, whether β-blocker therapy provides a similar benefit in patients who have coronary artery disease but not AMI or HF is unknown. A population of 4,304 patients who did not have HF but did have angiographically confirmed coronary artery disease(≥1 stenosis of ≥70%) without AMI at hospital presentation was evaluated. Baseline demographics, cardiac risk factors, clinical presentation, therapeutic procedures, and discharge medications were recorded. Patients were followed for a mean of 3.0±1.9 years(range 1 month to 6.9 years) for outcomes of all-cause death or AMI. Patients’average age was 65±11 years and 77%were men. Overall, 10%died and 5%had a nonfatal AMI. Discharge β-blocker prescription was associated with an increased event-free AMI survival rate for all-cause death(no βblocker 88.3%, βblocker 94.5%, p 0.001) and death/AMI(no βblocker 83.4%, βblocker 89.2%, p 0.001) but not non-fatal AMI(no βblocker 93.6%,βblocker 94.1%, p=0.60). After adjustment for 16 covariates, including statin prescription, angiotensin-converting enzyme inhibitor prescription, and type of baseline therapy, the effect of βblockers on the combination end point of death/AMI was eliminated. However, the effect of βblockers on death remained(hazard ratio 0.66, 95%confidence interval 0.47 to 0.93, p=0.02). Thus, βblockers are clearly indicated for most patients who have HF or AMI, and our results suggest that patients who have coronary artery disease without these conditions have approximately the same protective benefit against death. No effect was observed on longitudinal incidence of AMI or the combination of death/nonfatal MI.