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BIBTEX RIS

P3686Statin therapy improves glycemic control in diabetic patients admitted with acute coronary syndromes

2017; Oxford University Press; Volume: 38; Issue: suppl_1 Linguagem: Inglês

10.1093/eurheartj/ehx504.p3686

1522-9645

Remo H.M. Furtado, Talia Falcão Dalçóquio, Luciano Baracioli, Felipe Gallego Lima, André Franci, Fernando Menezes, Paulo Genestreti, Aline Ferrari, Vânia Mara Alves Lima, Roberto Kalil Filho, José Carlos Nicolau,

Lipoproteins and Cardiovascular Health

Background: Beta-blockers have been shown to improve the prognosis after acute myocardial infarction (MI) since the 1980s.Major guidelines recommend routine use in patients with both ST-elevation and non-ST-elevation MI.AHA guidelines recommend initiation within the first 24 hours in patients without contraindication, while ESC guidelines remain conservative on it by mentioning that it is prudent to wait for the patient to stabilize before starting a beta-blocker.The best timing of the initiation of oral beta-blocker still remains controversial.Purpose: This study sought to investigate the associations between initiation time of carvedilol, a widely prescribed oral beta-blocker, and both short and long term survival after acute MI.Methods: We conducted a retrospective cohort study comprising 412 consecutive patients admitted with a diagnosis of acute MI between January 2007 and August 2016, who underwent successful primary percutaneous coronary intervention (PCI), and were given carvedilol during hospitalization.We categorized the patients into early and late oral beta-blocker group, based on whether carvedilol was initiated within the first 24 hours.Primary outcomes were in-hospital mortality and time to all-cause death.Median follow-up period was 828 days.We performed bivariate analysis, multivariate analyses, and propensity score matching for 25 baseline characteristics.Results: Patients with in-hospital death were observed to have older age, lower body mass index, higher prevalence of chronic kidney disease, lower initial blood pressure, lower initial left ventricular ejection fraction, higher N-terminal pro-Btype natriuretic peptide level, higher peak creatine kinase-MB level, more catecholamine use, and late carvedilol initiation.Logistic regression analysis showed that late carvedilol initiation was independently associated with in-hospital mortality (P<0.01).Cox proportional hazard regression analysis adjusted for baseline characteristics demonstrated that early initiation of carvedilol independently reduced long-term all-cause mortality (hazard ratio 0.17, 95% confidence interval 0.04-0.61,P<0.01).Comparison of propensity score matched groups (n=42, each) also revealed that early initiation of oral carvedilol was associated with less in-hospital (P<0.05) and long-term mortality (P<0.05; Figure ). Survival in propensity matched groupsConclusion: Initiation of oral carvedilol within the first 24 hours reduced the risk of in-hospital, as well as long-term mortality in acute MI patients who underwent successful primary PCI.Future larger scale studies focusing on the initiation timing of oral beta-blockers in the primary PCI era are warranted.