Most Read Articles
4 days ago
Ivermectin confers benefits in the treatment of COVID-19, with a recent study showing that its use helps reduce the risk of death especially in patients with severe pulmonary involvement.
3 days ago
Mental health comorbidities are common among patients with type 2 diabetes mellitus and may lead to worse outcomes, a recent study has found.
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

Tristan Manalac, 18 Nov 2020
The substitution of isoleucine to leucine at amino acid 97 (I97L) in the core region of the hepatitis B virus (HBV) seems to reduce its potency, decreasing the efficiency of both infection and the synthesis of the virus’ covalently closed circular (ccc) DNA, reports a new study presented at The Liver Meeting Digital Experience by the American Association for the Study of Liver Diseases (AASLD 2020).

Beta-blockers, ACEI/ARBs improve survival in revascularized AMI patients

Tristan Manalac
23 Sep 2020

Both beta-blockers (BBs) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) reduce mortality risk in patients with acute myocardial infarction (AMI) managed with revascularization, according to a recent Singapore study.

Moreover, combining both medication types seems to yield the best results, minimizing all-cause mortality and heart failure (HF) hospitalization.

“Our study findings conflict with that of other contemporary observation studies, highlighting continuing knowledge gaps in the appropriate use of BB and ACEI/ARB among patients with AMI in the current treatment era,” researchers said.

A total of 15,073 AMI patients (median age, 58 years; 83.2 percent male) were included in the present analysis, most of which had ST-elevation myocardial infarction (STEMI). All patients underwent in-hospital revascularization. More patients were on BB than ACEI/ARB medication (87.7 percent vs 74.2 percent); 66.8 percent were taking both, while <5 percent (n=742) were on neither medication. [Sci Rep 2020;10:15184]

Major adverse cardiovascular events (MACEs), defined as a composite of all-cause mortality and hospitalization for HF or MI, occurred in 11.1 percent (n=1,671) of patients at the 12-month follow-up. In terms of individual components, 4.0 percent were hospitalized for MI, 5.1 percent were admitted for HF, and 3.5 percent died.

Use of BBs at discharge significantly lowered the risk of the composite MACE endpoint (adjusted hazard ratio [HR], 0.80, 95 percent confidence interval [CI], 0.70–0.93) and all-cause mortality (adjusted HR, 0.69, 95 percent CI, 0.55–0.88).

In comparison, ACEI/ARB use lowered the likelihood of all-cause mortality (adjusted HR, 0.80, 95 percent CI, 0.66–0.98) and HF hospitalization (adjusted HR, 0.80, 95 percent CI, 0.68–0.95). Neither medication eased the risk of MI hospitalization.

Notably, taking both BBs and ACEI/ARBs had the strongest effect in reducing the risk of the composite MACE outcome (adjusted HR, 0.70, 95 percent CI, 0.57–0.86), as well as its all-cause mortality (adjusted HR, 0.55, 95 percent CI, 0.40–0.77) and HF hospitalization (adjusted HR, 0.64, 95 percent CI, 0.48–0.86) components. This analysis used the subgroup of patients who took neither medication as reference.

“Our study represents a contemporary national registry with high standards of background care in pharmacotherapy,” the researchers said. “In addition, 24-hour nationwide primary percutaneous coronary intervention has been the standard of care for STEMI in Singapore since 2007.”

“To our knowledge, our cohort is the largest registry of AMI who underwent in-hospital revascularization that study the association of BB and ACEI/ARB with MACE, allowing robust subgroup comparisons,” they added.

Nevertheless, the present findings show some degree of departure from the current literature, the researchers said. Although trials in the past have shown that ACEI/ARBs may protect against adverse outcomes in AMI patients, more contemporary observational studies have found the drug class to be of no particular benefit.

“While randomized trials of BB are ongoing in contemporarily managed AMI populations, we propose that the role ACEI/ARB treatment also be re-examined in randomized trials of patients with AMI who undergo early revascularization and are already receiving high levels of dual antiplatelet and lipid-lowering therapy,” they said.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
4 days ago
Ivermectin confers benefits in the treatment of COVID-19, with a recent study showing that its use helps reduce the risk of death especially in patients with severe pulmonary involvement.
3 days ago
Mental health comorbidities are common among patients with type 2 diabetes mellitus and may lead to worse outcomes, a recent study has found.
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

Tristan Manalac, 18 Nov 2020
The substitution of isoleucine to leucine at amino acid 97 (I97L) in the core region of the hepatitis B virus (HBV) seems to reduce its potency, decreasing the efficiency of both infection and the synthesis of the virus’ covalently closed circular (ccc) DNA, reports a new study presented at The Liver Meeting Digital Experience by the American Association for the Study of Liver Diseases (AASLD 2020).