Objectives: The role of β-blockers in the treatment of hypertension is discussed controversially and the data showing a clear benefit in acute coronary syndromes (ACS) were obtained in the thrombolysis era. The goal of this study was to analyze the role of pretreatment with β-blockers in patients with ACS. Methods: Using data from the Acute Myocardial Infarction in Switzerland (AMIS Plus) registry, we analyzed outcomes of patients with β-blocker pretreatment in whom they were continued during hospitalization (group A), those without β-blocker pretreatment but with administration after admission (group B) and those who never received them (group C). Major adverse cardiac events defined as composed endpoint of re-infarction and stroke (during hospitalization) and/or in-hospital death were compared between the groups. Results: A total of 24,709 patients were included in the study (6,234 in group A, 12,344 in group B, 6,131 in group C). Patients of group B were younger compared to patients of group A and C (62.5, 67.6 and 68.4, respectively). In the multivariate analysis, odds ratio for major adverse cardiac events was 0.59 (CI 0.47–0.74) for group A and 0.66 (CI 0.55–0.83) for group B, while group C was taken as a reference. Conclusions: β-Blocker therapy is beneficial in ACS and they should be started in those who are not pretreated and continued in stable patients who had been on chronic β-blocker therapy before.

Keywords:
Acute coronary syndrome, Acute myocardial infarction, β-Receptor blockers, β-Blockers, In-hospital mortality, AMIS
1.
Lindholm LH, Carlberg B, Samuelsson O: Should β blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005;366:1545–1553.
2.
Messerli FH, Williams B, Ritz E: Essential hypertension. Lancet 2007;370:591–603.
3.
Smith SC, Jr, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, Grundy SM, Hiratzka L, Jones D, Krumholz HM, Mosca L, Pasternak RC, Pearson T, Pfeffer MA, Taubert KA: AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006;113:2363–2372.
4.
Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, Lamas GA, Mullany CJ, Pearle DL, Sloan MA, Smith SC Jr, Anbe DT, Kushner FG, Ornato JP, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW: 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation 2008;117:296–329.
5.
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE 2nd, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B: ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007;50:e1–e157.
6.
Lopez-Sendon J, Swedberg K, McMurray J, Tamargo J, Maggioni AP, Dargie H, Tendera M, Waagstein F, Kjekshus J, Lechat P, Torp-Pedersen C: Expert consensus document on β-adrenergic receptor blockers. Eur Heart J 2004;25:1341–1362.
7.
Freemantle N, Cleland J, Young P, Mason J, Harrison J: β Blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999;318:1730–1737.
8.
The β-Blocker Pooling Project (BBPP): Subgroup findings from randomized trials in post infarction patients. The β-Blocker Pooling Project Research Group. Eur Heart J 1988;9:8–16.
9.
Gottlieb SS, McCarter RJ, Vogel RA: Effect of β-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998;339:489–497.
10.
Hjalmarson A, Elmfeldt D, Herlitz J, Holmberg S, Malek I, Nyberg G, Ryden L, Swedberg K, Vedin A, Waagstein F, Waldenstrom A, Waldenstrom J, Wedel H, Wilhelmsen L, Wilhelmsson C: Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomised trial. Lancet 1981;2:823–827.
11.
Randomised trial of intravenous atenolol among 16027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group. Lancet 1986;ii:57–66.
12.
Van de Werf F, Janssens L, Brzostek T, Mortelmans L, Wackers FJ, Willems GM, Heidbuchel H, Lesaffre E, Scheys I, Collen D, et al: Short-term effects of early intravenous treatment with a β-adrenergic blocking agent or a specific bradycardiac agent in patients with acute myocardial infarction receiving thrombolytic therapy. J Am Coll Cardiol 1993;22:407–416.
13.
Roberts R, Rogers WJ, Mueller HS, Lambrew CT, Diver DJ, Smith HC, Willerson JT, Knatterud GL, Forman S, Passamani E, et al: Immediate versus deferred beta-blockade following thrombolytic therapy in patients with acute myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) II-b study. Circulation 1991;83:422–437.
14.
Pfisterer M, Cox JL, Granger CB, Brener SJ, Naylor CD, Califf RM, van de Werf F, Stebbins AL, Lee KL, Topol EJ, Armstrong PW: Atenolol use and clinical outcomes after thrombolysis for acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA (Alteplase) for Occluded Coronary Arteries. J Am Coll Cardiol 1998;32:634–640.
15.
Halkin A, Grines CL, Cox DA, Garcia E, Mehran R, Tcheng JE, Griffin JJ, Guagliumi G, Brodie B, Turco M, Rutherford BD, Aymong E, Lansky AJ, Stone GW: Impact of intravenous β-blockade before primary angioplasty on survival in patients undergoing mechanical reperfusion therapy for acute myocardial infarction. J Am Coll Cardiol 2004;43:1780–1787.
16.
Harjai KJ, Stone GW, Boura J, Grines L, Garcia E, Brodie B, Cox D, O’Neill WW, Grines C: Effects of prior β-blocker therapy on clinical outcomes after primary coronary angioplasty for acute myocardial infarction. Am J Cardiol 2003;91:655–660.
17.
Chen ZM, Pan HC, Chen YP, Peto R, Collins R, Jiang LX, Xie JX, Liu LS: Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: Randomised placebo-controlled trial. Lancet 2005;366:1622–1632.
18.
Kjekshus JK: Importance of heart rate in determining β-blocker efficacy in acute and long-term acute myocardial infarction intervention trials. Am J Cardiol 1986;57:43F–49F.
19.
Gundersen T, Grottum P, Pedersen T, Kjekshus JK: Effect of timolol on mortality and reinfarction after acute myocardial infarction: prognostic importance of heart rate at rest. Am J Cardiol 1986;58:20–24.
20.
Fox K, Ford I, Steg PG, Tendera M, Ferrari R: Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet 2008;372:807–816.
21.
Cuculi F, Radovanovic D, Eberli FR, Stauffer JC, Bertel O, Erne P: The impact of statin treatment on presentation mode and early outcomes in acute coronary syndromes. Cardiology 2008;109:156–162.
22.
Radovanovic D, Erne P, Urban P, Bertel O, Rickli H, Gaspoz JM: Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20,290 patients from the AMIS Plus registry. Heart 2007;93:1369–1375.
23.
Schoenenberger AW, Radovanovic D, Stauffer JC, Windecker S, Urban P, Eberli FR, Stuck AE, Gutzwiller F, Erne P: Age-related differences in the use of guideline-recommended medical and interventional therapies for acute coronary syndromes: A cohort study. J Am Geriatr Soc 2008;56:510–516.
24.
Urban P, Radovanovic D, Erne P, Stauffer JC, Pedrazzini G, Windecker S, Bertel O: Impact of changing definitions for myocardial infarction: a report from the AMIS registry. Am J Med 2008;121:1065–1071.
25.
Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.
26.
Silvet H, Spencer F, Yarzebski J, Lessard D, Gore JM, Goldberg RJ: Communitywide trends in the use and outcomes associated with β-blockers in patients with acute myocardial infarction: the Worcester Heart Attack Study. Arch Intern Med 2003;163:2175–2183.
27.
Batchelor WB, Anstrom KJ, Muhlbaier LH, Grosswald R, Weintraub WS, O’Neill WW, Peterson ED: Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians. J Am Coll Cardiol 2000;36:723–730.
28.
Gravina Taddei CF, Weintraub WS, Douglas JS Jr, Ghazzal Z, Mahoney E, Thompson T, King S III: Influence of age on outcome after percutaneous transluminal coronary angioplasty. Am J Cardiol 1999;84:245–251.
29.
Jeger RV, Radovanovic D, Hunziker PR, Pfisterer ME, Stauffer JC, Erne P, Urban P: Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med 2008;149:618–626.
30.
Stolt V, Goy JJ, Stauffer JC, Radovanovic D, Duvoisin N, Urban P, Bertel O, Erne P: Significant decrease of in-hospital mortality and major adverse cardiac events in Swiss STEMI patients between 2000 and December 2007. Swiss Med Wkly 2009;139:453–457.
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