Has the ClOpidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT) of early β-blocker use in acute coronary syndromes impacted on clinical practice in Canada? Insights from the Global Registry of Acute Coronary Events (GRACE)

被引:8
作者
Edwards, Jeremy [1 ]
Goodman, Shaun G. [1 ,2 ]
Yan, Raymond T. [2 ]
Welsh, Robert C. [3 ]
Kornder, Jan M. [4 ]
DeYoung, J. Paul [5 ]
Chauret, Denis [6 ]
Picard, Jean-Pierre [7 ]
Eagle, Kim A. [8 ]
Yan, Andrew T. [1 ,2 ]
机构
[1] Univ Toronto, Div Cardiol, Terrence Donnelly Heart Ctr, St Michaels Hosp, Toronto, ON M5B 1W8, Canada
[2] Canadian Heart Res Ctr, Toronto, ON, Canada
[3] Mazankowksi Alberta Heart Inst, Edmonton, AB, Canada
[4] Surrey Mem Hosp, Surrey, BC, Canada
[5] Cornwall Community Hosp, Cornwall, ON, Canada
[6] Univ Ottawa, Ottawa, ON, Canada
[7] Hop Hotel Dieu Sorel, Sorel Tracy, PQ, Canada
[8] Univ Michigan Hlth Syst, Ann Arbor, MI USA
关键词
HEART-FAILURE; THERAPY; MANAGEMENT; TRENDS; CARE; MORTALITY; DISCHARGE; PATTERNS; OUTCOMES; AGE;
D O I
10.1016/j.ahj.2010.10.034
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background The COMMIT/CCS-2 trial, published in 2005, demonstrated no net benefit of early beta-blocker (BB) therapy in acute coronary syndromes (ACS). We sought to assess the short-term impact of this landmark trial by comparing the use of early BB therapy in patients with a broad spectrum of ACS before and after 2005. Methods Using data from the Global Registry of Acute Coronary Events and Canadian Registry of Acute Coronary Events, we compared the rates of BB use within the first 24 hours of presentation in the periods 1999 to 2005 and 2006 to 2008, after stratifying patients by the type of ACS (ST-segment elevation myocardial infarction [STEMI] and non-ST-segment elevation ACS [NSTEACS]) and clinical presentation. Results Of the 14,231 patients with ACS, 77.7% received BB therapy within 24 hours of presentation (78.5% and 77.4% in the STEMI and NSTEACS groups, respectively). The early use of BB declined in the STEMI group (80.3% to 76.7%, P = .005) but increased in the NSTEACS group (75.4% to 78.9%, P < .001) after 2005. Long-term BB use, higher systolic blood pressure, and higher heart rate were independent predictors of early BB use. Conversely, patients who were female, older, Killip class >1, and had cardiac arrest at presentation were less likely to receive early BB. Multivariable analysis showed a trend toward lower use of BB among patients with STEMI (adjusted odds ratio 0.76, 95% CI 0.57-1.00, P = .055) and a trend toward more frequent BB use among patients with NSTEACS (adjusted odds ratio 1.22, 95% CI 0.96-1.55, P = .11) after 2005. The temporal trends in the early use of BB differed between patients with STEMI and patients with NSTEACS (P for interaction with period < . 001). Conclusions Most patients with STEMI or NSTEACS were treated with early BB therapy. In accordance with the COMMMIT/CCS-2 trial, patients with lower systolic blood pressure and higher Killip class in the "real world" less frequently received early BB therapy. Since the publication of COMMIT/CCS-2, there has been no significant change in the use of BB in patients with STEMI or NSTEACS after controlling for their clinical characteristics. (Am Heart J 2011;161:291-7.)
引用
收藏
页码:291 / 297
页数:7
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