Beta-blockers for post-acute coronary syndrome mid-range ejection fraction: a nationwide retrospective study

Background: Patients with mid-range ejection fraction (40–49%) are in focus due to the newly defined entity of heart failure with mid-range ejection fraction. Acute coronary syndromes are a major aetiology for heart failure with mid-range ejection fraction. We aim to evaluate which therapeutic decis...

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Published in:European heart journal. Acute cardiovascular care 2019-10, Vol.8 (7), p.599-605
Main Authors: Montenegro Sá, Fernando, Carvalho, Rita, Ruivo, Catarina, Santos, Luís Graça, Antunes, Alexandre, Soares, Francisco, Belo, Adriana, Morais, João
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - complications
Acute Coronary Syndrome - drug therapy
Acute Coronary Syndrome - physiopathology
Adrenergic beta-Antagonists - therapeutic use
Aged
Disease Progression
Female
Follow-Up Studies
Heart Failure - drug therapy
Heart Failure - etiology
Heart Failure - mortality
Hospital Mortality - trends
Humans
Male
Middle Aged
Portugal - epidemiology
Registries
Retrospective Studies
Risk Factors
Stroke Volume - physiology
Ventricular Function, Left - physiology
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Summary:Background: Patients with mid-range ejection fraction (40–49%) are in focus due to the newly defined entity of heart failure with mid-range ejection fraction. Acute coronary syndromes are a major aetiology for heart failure with mid-range ejection fraction. We aim to evaluate which therapeutic decisions are associated with inhospital survival benefit in post-acute coronary syndrome patients categorised according to the ejection fraction. Methods and results: The authors analysed a cohort of a multicentre national registry enrolling acute coronary syndrome patients between 2010 and 2016, classified according to their ejection fraction before hospital discharge. Patients with previously known heart failure or with no ejection fraction evaluation were excluded. A total of 9429 patients were included and categorised in three groups: (a) ejection fraction of 50% or greater (n=6113, 65%); (b) ejection fraction of 40–49% (n=1926, 20%); and (c) ejection fraction less than 40% (n=1390, 15%). The primary endpoint was inhospital mortality. To eliminate confounding factors, a multivariate logistic regression analysis was conducted, including acute coronary syndrome type, baseline characteristics, pharmacological treatment, clinical data, laboratory data and coronary anatomy when known. The overall inhospital mortality was 2.8% (n=263): 0.9% (n=53) in group 1, 2.4% (n=37) in group 2 and 11.4% (n=159) in group 3. After multivariate analysis, an invasive strategy had a positive impact in all groups, inhospital beta-blocker administration had a positive impact for groups 2 and 3, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and spironolactone had a positive impact on group 3. Conclusion: Post-acute coronary syndrome mid-range ejection fraction patients represent an intermediate risk group in which beta-blocker administration was associated with inhospital survival benefit. An invasive strategy was a survival predictor for all groups, regardless of ejection fraction category.
ISSN:2048-8726
2048-8734
DOI:10.1177/2048872619827476