Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Beta-blockers are required after ST-segment elevation myocardial infarction (STEMI). However, in patients at risk of cardiogenic shock, guidelines recommend against their use in the first 24 hours.
Research Question or Hypothesis: Is early beta-blocker use associated with cardiogenic shock after STEMI in patients with risk factors for shock?
Study Design: Retrospective chart review
Methods: Cardiogenic shock was assessed in adult patients with STEMI and percutaneous coronary intervention (PCI) with risk factors for shock (age above 70 years, systolic blood pressure below 120 mmHg, and heart rate above 120 bpm or below 60 bpm) who did or did not receive a beta-blocker 24 hours after PCI. Exclusion criteria were: presence of atrial fibrillation, pacemaker or implanted defibrillator; or beta-blocker intolerance. Data extraction occurred via manual chart review. Descriptive statistics were completed and T-tests, Chi-Squared, and Fisher’s Exact were used as appropriate. The risk of developing cardiogenic shock was assessed using multivariable logistic regression with evaluation of covariates with a p-value < 0.2. Alpha was set at < 0.05 and analyses were completed using SAS version 9.4 (SAS Institute INC., Cary, NC, USA).
Results: A total of 216 patients were included, 131 without an early beta-blocker and 85 with. Non beta-blocker versus beta-blocker patients had a mean (standard deviation) age of 64.29 (14.45) years versus 62.44 (13.55), p=0.3435; and peak troponin of 123.04 (209.77) ng/dL versus 101.37 (153.85), p=0.4473. Cardiogenic shock occurred in 12.21% (n=16) without early beta-blocker use versus 4.71% (n=4) with, p=0.0629. After backwards stepwise logistic regression, early beta-blocker use was not associated with cardiogenic shock (adjusted odd ratio [aOR] 0.350, 95% confidence interval (CI) 0.111-1.100; p=0.0724), but those with higher peak troponin had an over 3-fold increased risk of developing cardiogenic shock (aOR 3.376, 95% CI 1.311-8.694; p=0.0117).
Conclusion: Early beta-blocker administration in STEMI patients may not be associated with shock development.
Presenting Author
Nicole Castoro PharmD CandidateUniversity at Buffalo School of Pharmacy and Pharmaceutical Sciences
Authors
Lauren Lacoursiere BSc
University at Buffalo
Kevin Mills Pharm.D., BCPS, BCGP, BCCP
Buffalo General Medical Center
Maya Chilbert Pharm.D., BCCP
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Ashley Woodruff Pharm.D., BCPS
University at Buffalo School of Pharmacy and Pharmaceutical Sciences