心臓発作後のβ遮断薬の不必要な使用(Unnecessary use of beta-blockers after a heart attack)

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2024-04-07 カロリンスカ研究所(KI)

心臓発作後のβ遮断薬の不必要な使用(Unnecessary use of beta-blockers after a heart attack)Photo: Getty Images.

新英イングランド医学ジャーナルに掲載された研究によれば、心筋梗塞後にベータ遮断薬を不必要に処方される患者が半数に上ることが判明しました。この研究は、カロリンスカ研究所のトーマス・ヤーンベリ教授らによって率いられ、約5,000人の患者を対象に実施されました。その結果、ベータ遮断薬の投与が心筋梗塞後の死亡や再発率に有意な影響を与えないことが示され、治療が不要な患者が多いことが明らかになりました。

<関連情報>

心筋梗塞後のβ遮断薬と駆出率の維持 Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction

Troels Yndigegn, M.D., Bertil Lindahl, Ph.D., Katarina Mars, M.D., Joakim Alfredsson, Ph.D., Jocelyne Benatar, Ph.D., Lisa Brandin, Ph.D., David Erlinge, Ph.D., +12, for the REDUCE-AMI Investigators
New England Journal of Medicine  Published: April 7, 2024
DOI: 10.1056/NEJMoa2401479

Abstract

BACKGROUND
Most trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin–angiotensin–aldosterone system antagonists.

METHODS
In a parallel-group, open-label trial performed at 45 centers in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary end point was a composite of death from any cause or new myocardial infarction.

RESULTS
From September 2017 through May 2023, a total of 5020 patients were enrolled (95.4% of whom were from Sweden). The median follow-up was 3.5 years (interquartile range, 2.2 to 4.7). A primary end-point event occurred in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no–beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P=0.64). Beta-blocker treatment did not appear to lead to a lower cumulative incidence of the secondary end points (death from any cause, 3.9% in the beta-blocker group and 4.1% in the no–beta-blocker group; death from cardiovascular causes, 1.5% and 1.3%, respectively; myocardial infarction, 4.5% and 4.7%; hospitalization for atrial fibrillation, 1.1% and 1.4%; and hospitalization for heart failure, 0.8% and 0.9%). With regard to safety end points, hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred in 3.4% of the patients in the beta-blocker group and in 3.2% of those in the no–beta-blocker group; hospitalization for asthma or chronic obstructive pulmonary disease in 0.6% and 0.6%, respectively; and hospitalization for stroke in 1.4% and 1.8%.

CONCLUSIONS
Among patients with acute myocardial infarction who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of the composite primary end point of death from any cause or new myocardial infarction than no beta-blocker use. (Funded by the Swedish Research Council and others; REDUCE-AMI ClinicalTrials.gov number, NCT03278509.)

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