Beta-blocker choice may affect outcomes in cirrhosis and acute MI

Patients who took beta1-selective blockers had fewer major cardiac and cerebrovascular events within two years of an index myocardial infarction (MI) than those taking nonselective beta-blockers, a Taiwanese study found.

Patients with cirrhosis who have an acute myocardial infarction (MI) may have better outcomes with a beta1-selective blocker than with a nonselective beta-blocker, according to a new study.

Researchers in Taiwan used medical records from a national database to compare outcomes in patients with cirrhosis who were hospitalized for acute MI during 2001 to 2013. Patients were excluded if they were younger than age 20 years and if they had previous MI, a contraindication to beta-blockers, chronic obstructive pulmonary disease, asthma, or atrioventricular conduction disease. The authors also excluded patients who died during the index admission, whose follow-up was shorter than six months, whose medication ratio for beta1-selective or nonselective beta-blockers was less than 80%, or who switched between beta-blockers. The study's primary outcomes were cardiovascular events at one and two years, adverse outcomes related to the liver, and all-cause mortality. Results were published Sept. 20 by the Journal of the American Heart Association.

After propensity score matching, the analysis included 218 patients taking beta1-selective blockers and 218 patients taking nonselective beta-blockers. At one year, no difference in outcomes was seen between patients in each group. At two years, patients in the beta1-selective blocker group were at lower risk for major cardiac and cerebrovascular events than those taking nonselective beta-blockers (hazard ratio, 0.62; 95% CI, 0.42 to 0.91; P=0.015). This effect was also observed in subgroup analyses by age, sex, comorbid conditions, bleeding from esophageal varices, and cirrhosis severity. Trends were also noted for better rates of all-cause mortality and liver outcomes in the beta1-selective blocker group versus the nonselective beta-blocker group but did not reach statistical significance.

The authors noted that their study excluded a substantial proportion of patients and involved only patients in Taiwan, among other limitations. “In patients with liver cirrhosis, nonselective [beta]-blockers remain the cornerstone of medical treatment of portal hypertension due to the evidence derived from prospective trials of their efficacy in preventing variceal bleeding,” the authors wrote. However, they said that recent research on portal hypertension has raised concerns about the potentially harmful effects of the drugs in this population. They concluded that in their study, beta1-selective blockers were associated with lower risk for major cardiac and cerebrovascular events in patients with cirrhosis and acute MI after two years of follow-up, although liver outcomes and mortality rates did not differ significantly.