• Jeong Hoon Yang, Joo-Yong Hahn, Young Bin Song, Seung-Hyuk Choi, Jin-Ho Choi, Sang Hoon Lee, Joo Han Kim, Young-Keun Ahn, Myung-Ho Jeong, Dong-Joo Choi, Jong Seon Park, Young Jo Kim, Hun Sik Park, Kyoo-Rok Han, Seung Woon Rha, and Hyeon-Cheol Gwon.
• Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
• JACC Cardiovasc Interv. 2014 Jun 1;7(6):592-601.

ObjectivesThis study sought to investigate the association of beta-blocker therapy at discharge with clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI).BackgroundLimited data are available on the efficacy of beta-blocker therapy for secondary prevention in STEMI patients.MethodsBetween November 1, 2005 and September 30, 2010, 20,344 patients were enrolled in nationwide, prospective, multicenter registries. Among these, we studied STEMI patients undergoing primary PCI who were discharged alive (n = 8,510). We classified patients into the beta-blocker group (n = 6,873) and no-beta-blocker group (n = 1,637) according to the use of beta-blockers at discharge. Propensity-score matching analysis was also performed in 1,325 patient triplets. The primary outcome was all-cause death.ResultsThe median follow-up duration was 367 days (interquartile range: 157 to 440 days). All-cause death occurred in 146 patients (2.1%) of the beta-blocker group versus 59 patients (3.6%) of the no-beta-blocker group (p < 0.001). After 2:1 propensity-score matching, beta-blocker therapy was associated with a lower incidence of all-cause death (2.8% vs. 4.1%, adjusted hazard ratio: 0.46, 95% confidence interval: 0.27 to 0.78, p = 0.004). The association with better outcome of beta-blocker therapy in terms of all-cause death was consistent across various subgroups, including patients with relatively low-risk profiles such as ejection fraction >40% or single-vessel disease.ConclusionsBeta-blocker therapy at discharge was associated with improved survival in STEMI patients treated with primary PCI. Our results support the current American College of Cardiology/American Heart Association guidelines, which recommend long-term beta-blocker therapy in all patients with STEMI regardless of reperfusion therapy or risk profile.Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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