AUTHOR=Zhang Tao , Wang Xu , Zhang Yucheng , Feng Tingting , Zhou Yujie , Zhao Lin 

TITLE=Early β-blocker use and in-hospital outcomes in patients with chronic obstructive pulmonary disease hospitalized with acute coronary syndrome: findings from the CCC-ACS project

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1385943

DOI=10.3389/fcvm.2024.1385943

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Patients with chronic obstructive pulmonary disease (COPD) after acute coronary artery syndrome (ACS) are at an increased risk of heart failure and death. However, β-blockers have been underused in this population group due to concerns of adverse reactions.</p></sec><sec><title>Objective</title><p>This study aims to investigate the β-blocker prescription at admission and its impact on the in-hospital outcomes in patients with COPD after ACS in a Chinese national cohort.</p></sec><sec><title>Methods</title><p>Among 113,650 patients with ACS enrolled in the national registry of the Improving Care for Cardiovascular Disease in China between November 2014 and July 2019, a total of 1,084 ACS patients with COPD were included in this study. The primary endpoint was in-hospital mortality, and the secondary endpoint was the composite of in-hospital all-cause death and heart failure.</p></sec><sec><title>Results</title><p>Early oral β-blocker therapy was administered to 49.8% of patients. The Kaplan–Meier analysis showed that the early β-blocker treatment group had lower all-cause mortality (0.9% vs. 2.9%; <italic>P</italic> &lt; 0.05) and lower combined endpoint event rate (8.2% vs. 12.0%; <italic>P</italic> &lt; 0.05) compared to the those of the non-early β-blocker treatment group. The analysis of inverse probability of treatment weighting showed that the early β-blocker treatment group was associated with a significantly reduced incidence of all-cause death (risk ratio, 0.332, 0.119–0.923, <italic>P</italic> = 0.035), heart failure (risk ratio, 0.625, 95% CI 0.414–0.943, <italic>P</italic> = 0.025), and combined endpoint events (risk ratio: 0.616, 95% CI: 0.418–0.908, <italic>P</italic> = 0.014). In the subgroup of patients over 70 years of age, the corresponding hazard ratio was 0.268 (95% CI 0.077–0.938) for all-cause mortality and 0.504 (95% CI 0.316–0.805) for combined endpoint events.</p></sec><sec><title>Conclusion</title><p>β-blockers have been underused in patients with COPD and ACS in China. Early β-blocker therapy is associated with an improvement in in-hospital outcomes in patients with COPD after ACS.</p></sec><sec><title>Clinical Trial Registration</title><p><ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, identifier (NCT02306616).</p></sec>