Table 1.
Characteristics of the Study Population and Mortality by Beta-Blocker Dose
| Variable | Discharge Beta-Blocker | p Value |
Beta-Blocker Dose (% of the target dose) | p-value | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| No | Yes | No vs. Yes |
>0%–12.5% | >12.5%– 25% |
>25%–50% | >50% | Among 5 Doses |
Among 4 Beta- Blocker Doses |
||
| n (%) | 567 (8.5) | 6,115 (91.5) | 1,448 (21.7) | 2,247 (33.6) | 1,541 (23.1) | 809 (12.1) | ||||
| PATIENT CHARACTERISTICS | ||||||||||
| Age (years) mean ± SD | 65.1 ± 14.7 | 63.7 ± 13.5 | 0.03 | 64.5 ± 13.6 | 62.6 ± 13.6 | 64.0 ± 13.3 | 64.2 ± 13.1 | <0.0001 | 0.0001 | |
| Male n (%) | 349 (61.6) | 4,195 (68.6) | 0.0006 | 971 (67.1) | 1,555 (69.2) | 1,056 (68.5) | 570 (70.5) | 0.004 | 0.35 | |
| Race n (%) | 0.16 | 0.002 | 0.002 | |||||||
| White | 438 (77.2) | 4,851 (79.3) | 0.24 | 1,164 (80.4) | 1,792 (79.8) | 1,220 (79.2) | 617 (76.3) | 0.13 | 0.12 | |
| Black | 69 (12.2) | 654 (10.7) | 0.28 | 116 (8.0) | 226 (10.1) | 185 (12.0) | 120 (14.8) | <0.0001 | <0.0001 | |
| Asian | 6 (1.1) | 150 (2.5) | 0.04 | 39 (2.7) | 51 (2.3) | 37 (2.4) | 22 (2.7) | 0.24 | 0.82 | |
| American Indian | 3 (0.5) | 26 (0.4) | 0.73 | 6 (0.4) | 11 (0.5) | 8 (0.5) | 1 (0.1) | 0.68 | 0.52 | |
| Pacific Islander | 2 (0.4) | 13 (0.2) | 0.37 | 4 (0.3) | 4 (0.2) | 3 (0.2) | 1 (0.1) | 0.87 | 0.87 | |
| Unknown | 50 (8.8) | 428 (7.0) | 0.11 | 120 (8.3) | 164 (7.3) | 91 (5.9) | 49 (6.1) | 0.04 | 0.05 | |
| Other | 1 (0.2) | 7 (0.1) | 0.51 | 1 (0.1) | 1 (0.0) | 3 (0.2) | 1 (0.1) | 0.66 | 0.52 | |
| Hispanic n (%) | 33 (6.4) | 441 (7.7) | 0.27 | 126 (9.5) | 176 (8.4) | 87 (6.0) | 49 (6.3) | 0.002 | 0.002 | |
| BMI (kg/m2) Mean ± SD | 28.0 ± 6.8 | 29.2 ± 6.5 | <0.000 1 |
28.1 ± 6.0 | 29.2 ± 6.3 | 29.6 ± 6.8 | 30.4 ± 6.9 | <0.0001 | <0.0001 | |
| MEDICAL HISTORY | ||||||||||
| Diabetes n (%) | 152 (26.9) | 1,985 (32.5) | 0.006 | 399 (27.6) | 688 (30.7) | 533 (34.6) | 336 (41.6) | <0.0001 | <0.0001 | |
| Hypertension n (%) | 357 (63.1) | 4,177 (68.4) | 0.01 | 857 (59.2) | 1,465 (65.3) | 1,131 (73.4) | 666 (82.4) | <0.0001 | <0.0001 | |
| Hyperlipidemia n (%) | 276 (48.8) | 3,336 (54.6) | 0.008 | 723 (49.9) | 1,154 (51.4) | 893 (58.0) | 523 (64.8) | <0.0001 | <0.0001 | |
| Previous MI n (%) | 115 (20.3) | 1,277 (20.9) | 0.74 | 250 (17.3) | 411 (18.3) | 378 (24.6) | 217 (26.9) | 0.0000 | <0.0001 | |
| CHF history n (%) | 70 (12.4) | 635 (10.4) | 0.14 | 135 (9.3) | 177 (7.9) | 174 (11.3) | 137 (17.0) | <0.0001 | <0.0001 | |
| CABG history n (%) | 69 (12.2) | 815 (13.3) | 0.44 | 143 (9.9) | 238 (10.6) | 240 (15.6) | 178 (22.0) | <0.0001 | <0.0001 | |
| ESRD n (%) | 21 (3.7) | 204 (3.3) | 0.64 | 37 (2.6) | 66 (2.9) | 51 (3.3) | 45 (5.6) | 0.002 | 0.0009 | |
| CVA/TIA n (%) | 58 (10.2) | 640 (10.5) | 0.86 | 133 (9.2) | 199 (8.9) | 183 (11.9) | 115 (14.2) | <0.0001 | <0.0001 | |
| COPD n (%) | 102 (18.0) | 618 (10.1) | <0.000 1 |
150 (10.4) | 222 (9.9) | 150 (9.7) | 83 (10.3) | <0.0001 | 0.94 | |
| Current smoker n (%) | 206 (36.9) | 1,997 (33.1) | 0.08 | 486 (33.9) | 804 (36.2) | 482 (32.0) | 211 (26.5) | <0.0001 | <0.0001 | |
| ICD* n (%) | 18 (3.2) | 208 (3.4) | 0.78 | 41 (2.8) | 66 (2.9) | 57 (3.7) | 44 (5.4) | 0.009 | 0.004 | |
| MI CHARACTERISTICS | ||||||||||
| STEMI n (%) | 201 (35.4) | 2,691 (44.0) | 0.0001 | 717 (49.6) | 1,002 (44.6) | 651 (42.3) | 297 (36.7) | <0.0001 | <0.0001 | |
| Anterior | 60 (29.9) | 904 (33.6) | 0.28 | 247 (34.4) | 311 (31.0) | 231 (35.5) | 108 (36.4) | 0.17 | 0.16 | |
| Inferior/Posterior | 114 (56.7) | 1,356 (50.4) | 0.08 | 362 (50.5) | 524 (52.3) | 329 (50.5) | 127 (42.8) | 0.02 | 0.04 | |
| Thrombolytic Therapy n (%) |
25 (12.4) | 365 (13.6) | 0.65 | 79 (11.0) | 146 (14.6) | 105 (16.1) | 32 (10.8) | 0.03 | 0.02 | |
| Primary PCI n (%) | 147 (73.1) | 2,241 (83.3) | 0.0002 | 630 (87.9) | 864 (86.3) | 526 (80.8) | 203 (68.4) | <0.0001 | <0.0001 | |
| In-hospital revascularization (nonprimary PCI and CABG) n (%) |
41 (20.4) | 444 (16.5) | 0.15 | 105 (14.6) | 149 (14.9) | 115 (17.7) | 71 (23.9) | 0.001 | 0.001 | |
| Diagnostic angiography n (%) |
18 (9.0) | 132 (4.9) | 0.02 | 25 (3.5) | 41 (4.1) | 37 (5.7) | 28 (9.4) | <0.0001 | 0.0004 | |
| NSTEMI N (%) | 366 (64.6) | 3,424 (56.0) | 0.0001 | 731 (50.5) | 1,245 (55.4) | 890 (57.8) | 512 (63.3) | <0.0001 | <0.0001 | |
| Thrombolytic Therapy n (%) |
14 (3.8) | 95 (7.5) | 0.25 | 22 (3.0) | 38 (3.1) | 20 (2.2) | 14 (2.7) | 0.62 | 0.70 | |
| Primary PCI n (%) | 126 (34.4) | 1,409 (41.2) | 0.01 | 334 (45.7) | 565 (45.4) | 333 (37.5) | 159 (31.1) | <0.0001 | <0.0001 | |
| In-hospital revascularization (nonprimary PCI and CABG) n (%) |
84 (23.0) | 1,106 (32.3) | 0.0002 | 233 (31.9) | 409 (32.9) | 292 (32.8) | 164 (32.0) | 0.006 | 0.96 | |
| Diagnostic angiography N (%) |
72 (19.7) | 508 (14.8) | 0.01 | 97 (13.3) | 168 (13.5) | 143 (16.1) | 91 (17.8) | 0.008 | 0.05 | |
|
Admission SBP (mm Hg) Mean ± SD |
133.3 ± 31.2 | 141.0 ± 29.7 | <0.000 1 |
135.8 ± 27.5 | 140.1 ± 28.6 | 142.9 ± 30.6 | 148.7 ± 32.5 | <0.0001 | <0.0001 | |
|
Admission HR (beats/min) Mean ± SD |
82.9 ± 23.4 | 82.9 ± 21.2 | 0.94 | 81.3 ± 20.1 | 81.3 ± 20.2 | 84.2 ± 22.0 | 87.5 ± 23.6 | <0.0001 | <0.0001 | |
|
Heart Failure on Admission n (%) |
71 (12.5) | 616 (10.1) | 0.07 | 167 (11.5) | 179 (8.0) | 150 (9.7) | 112 (13.8) | <0.0001 | <0.0001 | |
| LVEF Mean ± SD | 48.8 ± 14.5 | 46.7 ± 12.8 | 0.001 | 45.3 ± 13.6 | 47.6 ± 12.4 | 46.4 ± 12.6 | 47.2 ± 12.8 | <0.0001 | <0.0001 | |
|
Troponin (ng/ml) Median (IQR) |
4.8 (1.3– 21.6) |
7.2 (2–28.1) | <0.000 1 |
12 (2.9– 42.5) |
7.2 (1.9– 28.8) |
6.2 (1.9– 22.4) |
4.3 (1.3– 17.7) |
<0.0001 | <0.0001 | |
| LOS Median (IQR) | 5 (3–9) | 5 (4–8) | 0.11 | 5 (4–8) | 4 (3–7) | 5 (4–8) | 6 (4–10) | <0.0001 | <0.0001 | |
| DISCHARGE MEDICATIONS | ||||||||||
|
BB Dose (% target) Mean ± SD |
12.0 ± 1.7 | 25.0 ± 0.4 | 49.1±3.2 | 100.3±29.0 | <0.0001 | |||||
| Mode (%) | 12.5 (92.4) | 25 (99.6) | 50 (93.1) | 100 (59.8) | ||||||
| Metoprolol n (%) | 923 (63.7) | 1,645 (73.2) | 1,052 (68.3) | 522 (64.5) | <0.0001 | |||||
| Carvedilol n (%) | 505 (34.9) | 468 (20.8) | 340 (22.1) | 174 (21.5) | <0.0001 | |||||
| ASA n (%) | 477 (84.1) | 5,708 (93.3) | <0.000 1 |
1,352 (93.4) | 2,099 (93.4) | 1,450 (94.1) | 745 (92.1) | <0.0001 | 0.33 | |
| ACE-I/ARB n (%) | 282 (49.7) | 4,150 (67.9) | <0.000 1 |
899 (62.1) | 1,541 (68.6) | 1,084 (70.3) | 581 (71.8) | <0.0001 | <0.0001 | |
| Statin n (%) | 404 (71.8) | 5,363 (87.8) | <0.000 1 |
1,246 (86.2) | 2,003 (89.2) | 1,330 (86.4) | 726 (89.7) | <0.0001 | 0.004 | |
| Clopidogrel n (%) | 333 (58.7) | 4,432 (72.5) | <0.000 1 |
1,034 (71.4) | 1,654 (73.6) | 1,118 (72.6) | 573 (70.8) | <0.0001 | 0.34 | |
| Dual antiplatelet n (%) | 314 (55.4) | 4,246 (69.4) | <0.000 1 |
997 (68.9) | 1,580 (70.3) | 1,074 (69.7) | 546 (67.5) | <0.0001 | 0.47 | |
| MORTALITY | ||||||||||
| 1 yr n (Kaplan-Meier %) | 97 (17.1) | 473 (7.7) | <0.000 1 |
117 (8.1) | 142 (6.4) | 136 (8.9) | 69 (8.6) | <0.0001 | 0.02 | |
| 2 yrs n (Kaplan-Meier %) | 123 (21.7) | 708 (11.7) | <0.000 1 |
165 (11.5) | 212 (9.5) | 197 (12.9) | 118 (14.7) | <0.0001 | 0.0002 | |
| 3 yrs n (Kaplan-Meier %) | 133 (25.4) | 795 (15.7) | <0.000 1 |
191 (16.2) | 237 (12.2) | 219 (17.6) | 131 (20.6) | <0.0001 | <0.0001 | |
*
includes patients with pre-admission ICD and those discharged with an ICD
ACE-I = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; ASA = aspirin; BB = beta-blocker; BMI = body mass index; CABG = coronary artery bypass graft surgery; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; CVA = cerebrovascular accident; ESRD = end stage renal disease; HR = heart rate; ICD = implantable cardioverter defibrillator; IQR = interquartile range; LOS = length of stay; LVEF = left ventricular ejection fraction; MI = myocardial infarction; PCI = percutaneous coronary intervention; SBP = systolic blood pressure; SD = standard deviation; STEMI = ST-segment elevation myocardial infarction; TIA = transient ischemic attack.