Beta-blocker Use in ST-segment Elevation Myocardial Infarction in the Reperfusion Era (GRACE)

UMMS Affiliation

Center for Outcomes Research

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Health Services Research


BACKGROUND: Current guidelines recommend early oral beta-blocker administration in the management of acute coronary syndromes for patients who are not at high risk of complications.

METHODS: Data from patients enrolled between 2000 and 2007 in the Global Registry of Acute Coronary Events (GRACE) were used to evaluate hospital outcomes in three cohorts of patients admitted with ST-elevation myocardial infarction, based on beta-blocker use (early [first 24 hours] intravenous [± oral], only early oral, or delayed [after first 24 hours]).

RESULTS: Among 13,110 patients with a ST-elevation myocardial infarction, 21% received any early intravenous beta-blockers, 65% received only early oral beta-blockers, and 14% received delayed (>24 hours) beta-blockers. Higher systolic blood pressure, higher heart rate, and chronic beta-blocker use were independent predictors of early beta-blocker use. Early beta-blocker use was less likely in older patients, patients with moderate to severe left ventricular dysfunction, and in those presenting with inferior myocardial infarction or Killip class III heart failure. Intravenous beta-blocker use and delayed beta-blocker use were associated with higher rates of cardiogenic shock, sustained ventricular fibrillation/ventricular tachycardia and acute heart failure, compared with oral beta-blocker use. In-hospital mortality was increased with IV beta-blocker use (propensity score adjusted odds ratio [OR] 1.41; 95% confidence interval [CI], 1.03-1.92) but significantly reduced with delayed beta-blocker administration (propensity adjusted OR, 0.44; 95% CI, 0.26-0.74).

CONCLUSIONS: Early beta-blocker use is common in patients presenting with ST-elevation myocardial infarction, with oral administration being most prevalent. Oral beta-blockers were associated with a decrease in the risk of cardiogenic shock, ventricular arrhythmias, and acute heart failure. However, the early receipt of any form of beta-blockers was associated with an increase in hospital mortality.


Clinical outcomes, Intravenous beta-blockers, Oral beta-blockers, STEMI

DOI of Published Version



Park KL, Goldberg RJ, Anderson FA, López-Sendón J, Montalescot G, Brieger D, Eagle KA, Wyman A, Gore JM; Global Registry of Acute Coronary Events Investigators. Beta-blocker use in ST-segment elevation myocardial infarction in the reperfusion era (GRACE). Am J Med. 2014 Jun;127(6):503-11. doi:10.1016/j.amjmed.2014.02.009. Link to article on publisher's website

Journal/Book/Conference Title

The American journal of medicine

Related Resources

Link to article in PubMed

PubMed ID