| アブストラクト | OBJECTIVE: A catecholamine-mediated mechanism has been implicated in the pathogenesis of Takotsubo cardiomyopathy (TC). However, the impact of beta-blockers in acute-phase management of TC remains uncertain. This study aimed to examine whether early beta-blocker use in TC was associated with lower in-hospital mortality. METHODS: This was a retrospective cohort study using the Diagnosis Procedure Combination nationwide inpatient database in Japan. Patients with TC aged >/=20 years who were admitted to acute-care hospitals between 2010 and 2014 were identified. Thirty-day in-hospital mortality was compared between patients who started beta-blocker therapy on hospitalisation day 1 or 2 (early beta-blocker group) and those who did not receive a beta-blocker during hospitalisation (control group) using propensity score-matching and instrumental variable analyses. RESULTS: Of 2672 eligible patients (female, 81.5%; 423 early beta-blocker therapy, 2249 controls) from 615 hospitals, 1:4 propensity score-matching created a cohort of 2110 patients (422 early beta-blocker therapy, 1688 controls). There was no significant difference in 30-day in-hospital mortality between the early beta-blocker group and control group (2.4% vs 2.0%, p=0.703; risk difference, 0.4%; 95% CI, -1.2% to 2.0%). Logistic regression analysis did not show a significant association between early beta-blocker use and 30-day in-hospital mortality (OR, 1.17; 95% CI 0.58 to 2.37). Instrumental variable analysis also found that early beta-blocker use was not associated with lower 30-day in-hospital mortality (risk difference, 1.2%; 95% CI -3.1% to 5.5%). CONCLUSIONS: This study found no significant association between early beta-blocker use and in-hospital mortality in patients with TC. |
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| ジャーナル名 | Heart (British Cardiac Society) |
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| Pubmed追加日 | 2016/02/18 |
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| 投稿者 | Isogai, Toshiaki; Matsui, Hiroki; Tanaka, Hiroyuki; Fushimi, Kiyohide; Yasunaga, Hideo |
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| 組織名 | Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, Tokyo, Japan Department of Cardiology, Tokyo;Metropolitan Tama Medical Center, Tokyo, Japan.;Health, The University of Tokyo, Tokyo, Japan.;Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.;Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo;Medical and Dental University, Tokyo, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/26879240/ |
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