Impact Of Beta-Blocker On Long-Term Prognosis In Patients With NSTE-ACS Undergoing Primary Percutaneous Coronary Intervention

Background and objective:In recent years, the incidence and mortality of coronary heart disease is increasing year by year. It is a serious threat to human health and one of the main causes of human death. With the progress of technology, percutaneous coronary intervention (PCI) has become an paramount treatment of coronary heart disease. Much of the research have indicated that PCI is beneficial to the patients with ST elevation myocardial infarction (STEMI) and high risk of UA/NSTEMI. For patients with coronary heart disease after PCI, the main causes of death are including sudden death, reinfarction and heart failure. A host of studies have showed that beta blocker can significantly reduce the mortality rate after PCI in patients with STEMI, and in the ACC/AHA guidelines recommend long-term oral beta blocker therapy in patients with STEMI. However, it is not clear whether beta blockers are beneficial in the long-term prognosis of patients with UA/NSTEMI.In this study, we investigate that the effects of beta blockers on the long-term prognosis of UA/NSTEMI using retrospective analysis, on the basis of dual antiplatelet therapy, lipid regulating drugs and other drugs, which can guiding clinical work.Methods:Between January 2014 to June 2014, we selected 398 patients with NSTE-ACS(337patients with UA and 61 patients with NSTEMI) undergoing primary percutaneous coronary intervention who were hospitalized in the Department of Cardiology, Qilu Hospital, Shandong University. We divided the patients into beta-blocker group (n=276) and no-beta-blocker group (n=122) according to the use of beta-blocker when they were discharged from the hospital. We record the general situation, medical history, experimental examination, coronary artery disease, drug therapy and so on. And than We observed the major adverse cardiovascular events (MACEs) in the two groups of patients with NSTE-ACS after primary PCI within an average of 20 months, including primary MACEs (all-cause death, nonfatal myocardial infarction, nonfatal stroke), and secondary MACEs (revascularization treatment, heart failure). Using multivariable COX regression assessed the association between beta-blocker and MACEs of the patients after primary PCI.Results:At the end of the long-term follow-up, the total of MACEs is 61cases (15.3%), including 33cases of beta-blocker group and no-beta-blocker group. Compared with patients of no-beta-blocker group, The incidence of MACEs of beta-blocker group is significant lower than no-beta-blocker group(12.0%:23.0%, P=0.013<0.05).Further use of multiple logistic regression analysis showed that beta-blocker can reduce the incidence of MACEs (OR=0.513,95%CI:0.281-0.935, P=0.030<0.05)Conclusions:Our study demonstrate that Long-term oral beta-blocker therapy may reduce the incidence of major adverse cardiovascular events in patients with NSTE-ACS primary percutaneous coronary intervention.Significance:For NSTE-ACS patients undergoing percutaneous coronary intervention (PCI), should be recommended taking long-term of beta blocker therapy, to reduce the incidence of major adverse cardiovascular events, even if the heart function is normal. This study has crucial clinical value and provides a basis of clinical work.