本文由小咖机器人翻译整理

期刊来源：N Engl J Med

原文链接：https://doi.org/10.1056/NEJMoa2401479

摘要内容如下：

背景

大多数显示心肌梗死后β受体阻滞剂治疗有益的试验包括大面积心肌梗死患者，并且是在基于现代生物标志物的心肌梗死诊断和经皮冠状动脉介入治疗、抗血栓药物、高强度他汀类药物和肾素-血管紧张素-醛固酮系统拮抗剂治疗之前进行的。

方法

在瑞典、爱沙尼亚和新西兰的45个中心进行的一项开放标签平行组试验中，我们将行冠状动脉造影且左心室射血分数≥50%的急性心肌梗死患者随机分为两组，一组接受长期β受体阻滞剂（美托洛尔或比索洛尔）治疗，另一组不接受β受体阻滞剂治疗。主要终点是任何原因导致的死亡或新发心肌梗死的复合终点。

结果

从2017年9月至2023年5月，共有5020名患者入选（其中95.4%来自瑞典）。中位随访时间为3.5年（四分位间距为2.2至4.7）。β-阻滞剂组2508例患者中有199例（7.9%）和非β-阻滞剂组2512例患者中有208例（8.3%）发生主要终点事件（风险比为0.96；95%置信区间，0.79至1.16；P=0.64）。β-受体阻滞剂治疗似乎并未降低次要终点（任何原因导致的死亡，β-受体阻滞剂组为3.9%，非β-受体阻滞剂组为4.1%；心血管死亡分别为1.5%和1.3%；心肌梗死，4.5%和4.7%；房颤住院率分别为1.1%和1.4%；心力衰竭住院率为0.8%和0.9%）。就安全性终点而言，β受体阻滞剂组和非β受体阻滞剂组分别有3.4%和3.2%的患者因心动过缓、二度或三度房室传导阻滞、低血压、晕厥或植入起搏器而住院。因哮喘或慢性阻塞性肺病住院的分别为0.6%和0.6%；脑卒中住院率分别为1.4%和1.8%。

结论

在接受早期冠状动脉造影且左心室射血分数正常（≥50%）的急性心肌梗死患者中，长期β受体阻滞剂治疗并未导致复合主要终点（任何原因导致的死亡或新发心肌梗死）的风险低于未使用β受体阻滞剂的患者。（由瑞典研究委员会和其他机构资助；REDUCE-AMI ClinicalTrials.gov编号，NCT03278509。）

英文原文如下：

Abstracts

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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