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Comparison of Early Versus Delayed Oral β Blockers in Acute Coronary Syndromes and Effect on Outcomes.

Bugiardini R1, Cenko E2, Ricci B2, Vasiljevic Z3, Dorobantu M4, Kedev S5, Vavlukis M5, Kalpak O5, Puddu PE6, Gustiene O7, Trninic D8, Kne?ević B9, Miličić D10, Gale CP11, Manfrini O2, Koller A12, Badimon L13.
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1Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. Electronic address: raffaele.bugiardini@unibo.it.
2Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
3Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia.
4Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, Bucharest, Romania.
5University Clinic of Cardiology, Medical Faculty, University of St.Cyril & Methodius, Skopje, Macedonia.
6Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
7Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
8University Clinical Center of the Republic of Srpska, Clinic of Cardiovascular Diseases, Banja Luka, Republika Srpska, Bosnia and Herzegovina.
9Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro.
10Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia.
11Division of Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom; York Teaching Hospital NHS Foundation Trust, United Kingdom.
12Institute of Natural Sciences, University of Physical Education, Budapest, Hungary; Department of Physiology, New York Medical College, Valhalla, New York.
13Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
The aim of this study was to determine if earlier administration of oral β ​blocker therapy in patients with acute coronary syndromes (ACSs) is associated with an increased short-term survival rate and improved left ventricular (LV) function. We studied 11,581 patients enrolled in the International Survey of Acute Coronary Syndromes in Transitional Countries registry from January 2010 to June 2014. Of these patients, 6,117 were excluded as they received intravenous β blockers or remained free of any β ​blocker treatment during hospital stay, 23 as timing of oral β ​blocker administration was unknown, and 182 patients because they died before oral β blockers could be given. The final study population comprised 5,259 patients. The primary outcome was the incidence of in-hospital mortality. The secondary outcome was the incidence of severe LV dysfunction defined as an ejection fraction <40% at hospital discharge. Oral β blockers were administered soon (≤24 hours) after hospital admission in 1,377 patients and later (>24 hours) during hospital stay in the remaining 3,882 patients. Early β ​blocker therapy was significantly associated with reduced in-hospital mortality (odds ratio 0.41, 95% CI 0.21 to 0.80) and reduced incidence of severe LV dysfunction (odds ratio 0.57, 95% CI 0.42 to 0.78). Significant mortality benefits with early β ​blocker therapy disappeared when patients with Killip class III/IV were included as dummy variables. The results were confirmed by propensity score-matched analyses. In conclusion, in patients with ACSs, earlier administration of oral β ​blocker therapy should be a priority with a greater probability of improving LV function and in-hospital survival rate. Patients presenting with acute pulmonary edema or cardiogenic shock should be excluded from this early treatment regimen.
Copyright © 2016 Elsevier Inc. All rights reserved.
PMID: 26778165 [PubMed - in process]

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