Post-MI beta-blocker use lowers mortality risk in COPD patients

Beta-blocker therapy following myocardial infarction (MI) reduces the risk of death in patients with comorbid chronic obstructive pulmonary disease (COPD), with the magnitude of benefit similar to that observed in patients without COPD, according to a Danish cohort study.

Researchers used data from the National Prescription Registry and other individual level registers. They identified patients discharged after hospitalization for MI.

A total of 96,567 MI survivors, of whom 10,884 (11.3 percent) had COPD, were included in the analyses. Compared with non-COPD patients, those with COPD were older (median age 75 vs 68 years) and more likely to have had non-ST-elevation MI (NSTEMI) (88.5 percent vs 79.5 percent). All-cause mortality was high in the presence of COPD both in STEMI (hazard ratio [HR], 1.60, 95 percent confidence interval [CI], 1.46–1.77) and NSTEMI (HR, 1.47, 95 percent CI, 1.43–1.52).

For COPD patients, beta-blocker use was associated with reduced risk of mortality regardless of the type of MI (STEMI: HR, 0.73, 95 percent CI, 0.61–0.88; NSTEMI: HR, 0.68, 95 percent CI, 0.65–0.72). The risk estimates associated with beta-blocker use were similar for patients without COPD.

Beta-blocker use also conferred survival benefit on high-risk COPD patients with severe COPD and frequent exacerbations (5-year mortality, 63.5 percent and 62.6 percent, respectively).

Similar results were obtained in analyses of cardiovascular mortality.

The findings indicate that beta-blocker treatment carries no increased mortality risk in COPD, regardless of COPD severity and dyspnoea score.