Abstract |
Sustained ventricular arrhythmias and heart failure are well-recognized complications after acute myocardial infarction (AMI) and have been associated with worse outcomes and increased mortality. The use of and outcomes associated with acute beta-blocker therapy in patients with AMI complicated by sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and heart failure were investigated. Of 5,391 patients in the VALIANT Registry, sustained VT/VF occurred in 306 (5.7%), with an in-hospital mortality rate of 20.3%. Multivariable logistic regression identified sustained VT/VF as a major predictor of in-hospital death (relative risk 4.18, 95% confidence interval 2.91 to 5.93). Of those with sustained VT/VF, 55.2% were treated with intravenous or oral beta blockade in the first 24 hours. After adjusting for baseline characteristics, propensity for acute beta-blocker use, and the interaction between Killip classification and beta-blocker therapy, beta-blocker therapy within 24 hours was associated with decreased in-hospital mortality in patients with sustained VT/VF (relative risk 0.28, 95% confidence interval 0.10 to 0.75, p = 0.013) without evidence of worsening heart failure. Patients with sustained VT/VF were less likely to receive beta blockers within 24 hours (p = 0.001). In conclusion, sustained VT/VF was common after AMI. In patients with sustained VT/VF, beta-blocker therapy in the first 24 hours after AMI was associated with decreased early mortality without worsening heart failure. Unfortunately, beta blockers were underused acutely in patients with sustained VT/VF.
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Authors | Jonathan P Piccini, Patrick M Hranitzky, Rakhi Kilaru, Jean-Lucien Rouleau, Harvey D White, Philip E Aylward, Frans Van de Werf, Scott D Solomon, Robert M Califf, Eric J Velazquez |
Journal | The American journal of cardiology
(Am J Cardiol)
Vol. 102
Issue 11
Pg. 1427-32
(Dec 01 2008)
ISSN: 1879-1913 [Electronic] United States |
PMID | 19026290
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Adrenergic beta-Antagonists
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Topics |
- Adrenergic beta-Antagonists
(therapeutic use)
- Aged
- Clinical Trials as Topic
- Death, Sudden, Cardiac
(prevention & control)
- Drug Prescriptions
(statistics & numerical data)
- Female
- Hospital Mortality
- Humans
- Incidence
- Logistic Models
- Male
- Middle Aged
- Multivariate Analysis
- Myocardial Infarction
(complications, physiopathology)
- Practice Patterns, Physicians'
- Registries
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Tachycardia, Ventricular
(drug therapy, etiology, mortality)
- Time Factors
- Ventricular Fibrillation
(drug therapy, etiology, mortality)
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