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dc.contributor.authorEmery, Michael
dc.contributor.authorLopez-Sendon, Jose
dc.contributor.authorSteg, Phillippe Gabriel
dc.contributor.authorAnderson, Frederick A. Jr.
dc.contributor.authorDabbous, Omar H.
dc.contributor.authorScheuble, Aliocha
dc.contributor.authorEagle, Kim A.
dc.contributor.authorGRACE Investigators
dc.date2022-08-11T08:08:08.000
dc.date.accessioned2022-08-23T15:44:05Z
dc.date.available2022-08-23T15:44:05Z
dc.date.issued2006-12-13
dc.date.submitted2011-09-23
dc.identifier.citationAm Heart J. 2006 Dec;152(6):1015-21. <a href="http://dx.doi.org/10.1016/j.ahj.2006.08.024">Link to article on publisher's site</a>
dc.identifier.issn0002-8703 (Linking)
dc.identifier.doi10.1016/j.ahj.2006.08.024
dc.identifier.pmid17161045
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27236
dc.description.abstractBACKGROUND: Early beta-blocker (BB) therapy improves outcomes in ST-segment elevation myocardial infarction; however, limited data are available on its early use and its impact in non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: We evaluated data from 7106 patients with NSTEMI, without contraindications to BBs, enrolled in the Global Registry of Acute Coronary Events between April 1999 and September 2004. Baseline characteristics, management, and outcomes were analyzed according to the use of oral (+/-intravenous) BB within 24 hours of presentation. Multivariable analysis was conducted adjusting for comorbidities using the Global Registry of Acute Coronary Events risk model (c statistic 0.83). RESULTS: Beta-blocker therapy was initiated within the first 24 hours in 76% of patients with NSTEMI (79% with Killip class I vs 62% with class II/III; P < .001). Failure to initiate BBs within the first 24 hours was associated with lower rates of subsequent BB therapy (P < .001) and other evidence-based therapies. Early BB therapy was correlated with lower hospital mortality for NSTEMI patients (OR 0.58, 95% CI 0.42-0.81) and for those with Killip class II/III (OR 0.39, 95% CI 0.23-0.68) with a trend toward lower mortality in the Killip class I group (OR 0.77, 95% CI 0.49-1.21). At 6 months postdischarge, early BB use was associated with lower mortality in NSTEMI patients (OR 0.75, 95% CI 0.56-0.997) with a trend toward lower mortality in patients with Killip class I or II/III. CONCLUSIONS: Many eligible patients do not receive early BB therapy. Treatment with early BBs may have a beneficial impact on hospital and 6-month mortality in all patients, including those presenting with heart failure.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=17161045&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.ahj.2006.08.024
dc.subjectAdrenergic beta-Antagonists
dc.subjectAged
dc.subjectDrug Administration Schedule
dc.subjectElectrocardiography
dc.subjectFemale
dc.subjectHeart Failure
dc.subjectHospital Mortality
dc.subjectHumans
dc.subjectMale
dc.subjectMyocardial Infarction
dc.subjectRegistries
dc.subjectTreatment Outcome
dc.subjectHealth Services Research
dc.titlePatterns of use and potential impact of early beta-blocker therapy in non-ST-elevation myocardial infarction with and without heart failure: the Global Registry of Acute Coronary Events
dc.typeJournal Article
dc.source.journaltitleAmerican heart journal
dc.source.volume152
dc.source.issue6
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace/56
dc.identifier.contextkey2254976
html.description.abstract<p>BACKGROUND: Early beta-blocker (BB) therapy improves outcomes in ST-segment elevation myocardial infarction; however, limited data are available on its early use and its impact in non-ST-segment elevation myocardial infarction (NSTEMI).</p> <p>METHODS: We evaluated data from 7106 patients with NSTEMI, without contraindications to BBs, enrolled in the Global Registry of Acute Coronary Events between April 1999 and September 2004. Baseline characteristics, management, and outcomes were analyzed according to the use of oral (+/-intravenous) BB within 24 hours of presentation. Multivariable analysis was conducted adjusting for comorbidities using the Global Registry of Acute Coronary Events risk model (c statistic 0.83).</p> <p>RESULTS: Beta-blocker therapy was initiated within the first 24 hours in 76% of patients with NSTEMI (79% with Killip class I vs 62% with class II/III; P < .001). Failure to initiate BBs within the first 24 hours was associated with lower rates of subsequent BB therapy (P < .001) and other evidence-based therapies. Early BB therapy was correlated with lower hospital mortality for NSTEMI patients (OR 0.58, 95% CI 0.42-0.81) and for those with Killip class II/III (OR 0.39, 95% CI 0.23-0.68) with a trend toward lower mortality in the Killip class I group (OR 0.77, 95% CI 0.49-1.21). At 6 months postdischarge, early BB use was associated with lower mortality in NSTEMI patients (OR 0.75, 95% CI 0.56-0.997) with a trend toward lower mortality in patients with Killip class I or II/III.</p> <p>CONCLUSIONS: Many eligible patients do not receive early BB therapy. Treatment with early BBs may have a beneficial impact on hospital and 6-month mortality in all patients, including those presenting with heart failure.</p>
dc.identifier.submissionpathcor_grace/56
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages1015-21


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