（英文原文）Efficacy of Chronic β-Blocker Therapy for Secondary Prevention onLong-Term Outcomes After Coronary Artery Bypass Grafting Surgery
Background—Conflicting results from recent observational studies raisedquestions concerning the benefit of β-blockers for patients undergoing coronaryartery bypass grafting (CABG). Furthermore, the efficacy of chronic β-blockertherapy in CABG patients after hospital discharge is uncertain.
Methodsand Results—The study included 5926 consecutivepatients who underwent CABG and were discharged alive. The prevalence andconsistency of β-blocker use were determined in patients with and without aprior history of myocardial infarction (MI). β-Blockers were always used in1280 patients (50.9%) with and 1642 (48.1%) without prior MI after CABG.Compared with always users (n=2922 [49.3%]), the risk of all-cause death wassignificantly higher among inconsistent β-blocker users (HR, 1.96; 95% CI, 1.50to 2.57), and never using of β-blockers was associated with increased risk ofboth all-cause death (1.42; 1.01 to 2.00) and the composite of adversecardiovascular events (1.29; 1.10 to 1.50). In the cohort without MI, the HRfor all-cause death was 1.70 (95% CI, 1.17 to 2.48) in inconsistent users and1.23 (0.76 to 1.99) in never users. In the MI cohort, mortality was higher forinconsistent users (HR, 2.14; 95% CI, 1.43 to 3.20) and for never users (1.59;1.07 to 2.63). Consistent results were obtained in equivalent sensitivityanalyses.
Conclusions—In patients with or without prior MI undergoing CABG, theconsistent use of β-blockers was associated with a lower risk of long-termmortality and adverse cardiovascular events. Strategies should be developed tounderstand and improve discharge prescription of β-blockers and long-termpatient adherence.
來源：CardioSource Journal scans（April 30，2015）
CABG後持續使用β-阻滯劑可降低長期死亡危險（中文摘要）
近日《循環》雜誌發表一項中國研究顯示，在接受冠脈搭橋術（CABG）、既往有或無心梗（MI）的患者中，持續使用β-阻滯劑與長期死亡及不良心血管事件危險下降有關。因此應制定相關的用藥策略以了解並提高出院後的β-阻滯劑處方量和患者的長期依從性。
由於近期的觀察性研究結果相互矛盾，因此人們對β-阻滯劑有益於CABG患者的理論提出質疑，另外對出院後CABG患者接受長期β-阻滯劑治療的效果還不確定。為此本研究納入5926例接受CABG後出院的患者，並在此前有或無MI病史的患者中確認β-阻滯劑的使用率和堅持情況。
結果顯示，CABG後一直使用β-阻滯劑的有和無MI患者分別為1280例（50.9%）和1642例48.1%）。與一直使用者相比（2922例，49.3%），不堅持使用β-阻滯劑患者的全因死亡危險顯著較高（HR：1.96），從不使用β-阻滯劑與全因死亡危險（HR：1.42）以及複合的不良心血管事件發生危險（HR：1.29）增加相關。在無MI患者隊列中，不堅持使用以及從不使用者的全因死亡HR分別為1.70和1.23。在有MI隊列中，不堅持使用（HR：2.14）和從不使用者（HR：1.59）的死亡率較高。在等效的敏感性分析中也獲得了一致的結果。