Impact of Diabetes Mellitus on Benefit of β-Blocker Therapy After

Myocardial Infarction

  https://doi.org/10.1016/j.amjcard.2023.04.022

 

Abstract

 

Background:

Beta blockers are uniformly recommended for all patients after myocardial infarction (MI), including those

with diabetes mellitus (DM). This study assesses the impact of β-blocker type

and dosing on survival in patients with DM after MI.

 

Methods:

A cohort of 6,682 patients in the

Outcomes of Beta-blocker Therapy After Myocardial Infarction

registry were discharged after MI. In this cohort, 2,137 patients had DM (32%).

Beta-blocker dose was indexed to the target daily dose used in randomized

clinical trials and reported as percentage. Dosage groups were: no β blocker,

>0% to 12.5%, >12.5% to 25%, >25% to 50%, and >50% of the target

dose. The overall mean discharge β-blocker dose in patients with DM was 42.7 ±

34.1% versus 35.9 ± 27.4% in patients without DM (p 12.5% to 25% dose category had the highest survival rates, whereas patients

in the >50% dose had the lowest survival rate among patients discharged on β

blockers (p 12.5% to 25% dose had a statistically

significant hazard ratio 0.450 (95% confidence interval 0.224 to 0.907,

p = 0.025). In patients with DM, there was no statistically

significant difference in 3-year mortality among those treated with metoprolol

versus carvedilol.

 

Conclusions:

In conclusion, our analysis in

patients with DM after MI suggested a survival benefit from β-blocker therapy,

with no apparent advantage to high- versus low-dose β-blocker therapy;

although, physicians tended to prescribe higher doses in patients with DM.

There was no survival benefit for carvedilol over metoprolol in patients with

DM.

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Episode ID: 1000615100879

GUID: 649598d9-e91b-4df3-a865-0a4a9cbce2fa

Release Date: 31/05/2023, 09:56:44