文献报告请示1230：bmjβ受体阻滞剂可改良俦发心梗的copd患者生计率 3[指南]课件.ppt

1、Effect of blockers on mortality after myocardial infarction in adults with COPD22 November 2013Page 2Patients with chronic obstructive pulmonary disease(COPD)are at increased risk of cardiovascular comorbidities,including myocardial infarction and have decreased short and long term survival after a

2、myocardial infarction compared with patients without COPDBackgroundPage 3BackgroundThere was a historical concern that blockers could be harmful in patients with COPD(for example,by inducing bronchospasm)Page 4BackgroundHowever,Increasing evidences have shown that blockers are safe and can actually

3、be beneficial in myocardial infarction patients with COPD.Page 5Objectives To investigate whether the use and timing of prescription of blockers in patients with chronic obstructive pulmonary disease(COPD)having a first myocardial infarction was associated with survival and to identify factors relat

4、ed to their use.Page 6Methodspopulation based cohort study in EnglandPatients with COPD with a first myocardial infarction in 2003 to 20081063 patients were included in this study.The median length of follow-up after myocardial infarction was 2.9 years(range 0.09-7.2 years).Page 7Methods Cox proport

5、ional hazards ratio for mortality after myocardial infarction in patients with COPD in those prescribed blockers or not,corrected for covariates including age,sex,smoking status,drugs,comorbidities,type of myocardial infarction,and severity of infarct.Page 8ResultsPatients with COPD prescribed a blo

6、cker during the hospital admission for myocardial infarction were younger Page 9Resultsless likely to have a history of other cardiovascular diseases before their myocardial infarction.Page 10ResultsThey were also more likely to have infrequent exacerbations and less likely to have been prescribed d

7、iuretics before the myocardial infarction.Page 11ResultsPage 12ResultsAmong 1063 patients with COPD,treatment with blockers started during the hospital admission for myocardial infarction was associated with substantial survival benefits.Patients already taking a blocker before their myocardial infa

8、rction also had a survival benefit.Page 13ConclusionThe use of blockers started either at the time of hospital admission for myocardial infarction or before a myocardial infarction is associated with improved survival after myocardial infarction in patients with COPD.Page 14DiscussionPatients not pr

9、escribed blockers during the hospital admission for myocardial infarction were more likely to be taking inhalers for their COPD and might have been more likely to have symptoms from their COPD.Page 15DiscussionPatients with COPD prescribed blockers during the hospital admission for myocardial infarc

10、tion are at a higher risk of death having just had a myocardial infarction and this might be why they are more effective in this group.Page 16DiscussionThose prescribed blockers before myocardial infarction might have been given blockers for reasons other than ischaemic heart disease and thus be a more heterogeneous group.