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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0070" class="elsevierStylePara elsevierViewall">The role of beta-blockers is clearly established for secondary prevention in all current guidelines for the management of patients with acute coronary syndromes &#40;ACS&#41;&#44; particularly in the presence of left ventricular &#40;LV&#41; dysfunction&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#44;2</span></a> Beta-blockers improve outcome in coronary artery disease by reducing oxygen demand and hence ischemia&#44; attenuating ventricular remodeling&#44; and preventing lethal arrhythmias and sudden death&#46; However&#44; the majority of studies that support these effects were performed between the 1970s and the 1990s&#44; before major advances in therapy such as the introduction of reperfusion therapy and modern pharmacotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#8211;10</span></a> Beta-blockers have not been investigated in contemporary trials&#44; although it is not unreasonable to extrapolate their benefits to this setting&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Each successive intervention that reduces risk reduces the absolute benefit of further interventions&#46; Dramatic decreases in mortality were observed in the early 21st century in several ACS registries&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#8211;17</span></a> As the baseline risk of a population decreases due to a new intervention&#44; the incremental benefit of previous interventions needs to be re-evaluated&#46; Currently&#44; most ACS patients are discharged without significant residual ischemia&#44; and the risk of lethal arrhythmias is extremely low because remodeling and even quite large reductions in LV ejection fraction &#40;LVEF&#41; with heart failure are not a significant problem with contemporary treatment&#46; A more recent study in stable CAD patients challenged the use of beta-blockers&#44; further reinforcing the need for reassessment of their benefit in a contemporary cohort of patients with ACS&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> Also&#44; current guidelines do not provide a definite recommendation for the use of beta-blockers in patients with ACS and normal or mildly reduced LVEF &#40;&#8805;40&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">It was our objective to assess the role of beta-blockers in a contemporary population of patients with ACS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0085" class="elsevierStylePara elsevierViewall">All consecutive adult patients &#40;aged &#8805;18 years&#41; admitted to our intensive care unit with ACS were prospectively included in our center&#39;s ACS registry between January 2005 and November 2015 and were included in the present study&#46; Criteria for inclusion were a history of chest pain at rest or other symptoms suggestive of ACS &#40;the most recent episode within 48 hours of admission&#41; with or without new or presumed new significant ST-segment or T-wave changes&#44; new left bundle branch block and elevated biomarkers of myocardial damage with a rise and&#47;or fall in levels&#46; Myocardial infarction &#40;MI&#41; was defined according to the universal definition of type 1 MI&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> A diagnosis of ST-elevation MI &#40;STEMI&#41; was made in the presence of persistent &#40;&#62;30 min&#41; ST-segment elevation&#46; All other cases were considered non-ST elevation ACS &#40;NSTE-ACS&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Data were collected in a dedicated electronic database&#44; and included demographic&#44; clinical and patient-management related characteristics&#44; as well as clinical outcome&#46; Hypertension&#44; diabetes and hyperlipidemia were defined as either previously known or on specific therapy&#46; If patients had smoked during the previous six months they were classified as smokers and were self-reported&#46; Decisions on patient management strategy&#44; including referral for coronary angiography and mode of myocardial revascularization&#44; if any&#44; were at the discretion of the attending physician&#46; LVEF was obtained before discharge by echocardiography&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Follow-up was obtained for every patient who survived to discharge by reviewing medical records and&#47;or by telephone interview with the patient or family members&#46; The primary endpoint was all-cause mortality at one-year follow-up&#46; In-hospital secondary endpoints were cardiac arrest&#44; complete atrioventricular &#40;AV&#41; block&#44; mechanical complications&#44; stroke&#47;transient ischemic attack &#40;TIA&#41;&#44; LV function&#44; major bleeding &#40;according to the Global Use of Strategies to Open Occluded Coronary Arteries &#91;GUSTO&#93; criteria&#41;&#44; and all-cause mortality during the index hospitalization and at 30-day follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">All procedures contributing to this work comply with the ethical standards of the 1975 Helsinki Declaration&#46; This research does not involve human or animal experimentation&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0105" class="elsevierStylePara elsevierViewall">Continuous variables are reported as means and standard deviation and were compared with the Student&#39;s t test&#46; Normality tests were performed with the Kolmogorov-Smirnov test and homogeneity of variance was tested with Levene&#39;s test&#46; Continuous variables without normal distribution are reported as medians and interquartile range and were compared with the Mann-Whitney test&#46; Categorical variables are reported as percentages and differences between groups were tested with the chi-square test or Fischer&#39;s exact test&#44; as appropriate&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Propensity-score matching was performed to adjust for the non-randomized assignment of patients to treatment and for the potential bias due to differences between the study groups&#46; Propensity scoring helps deal with bias arising from confounding by indication&#44; enabling a more accurate comparison of outcomes between participants with similar propensity scores based on the set of available information about that individual&#46; A propensity score was calculated for each participant by logistic regression as the likelihood of being assigned to treatment with a beta-blocker&#46; The model included all variables that in the logistic analysis had a p-value &#60;0&#46;05&#46; A 1&#58;2 matched analysis was then performed on the basis of each patient&#39;s estimated propensity score&#46; Baseline and in-hospital characteristics were then compared&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Estimates of event-free survival at one-year follow-up were calculated by the Kaplan-Meier method and survival curves were compared with the log-rank test&#46; A Cox proportional-hazards regression model was used with the p level for entry into and removal from the model set at 0&#46;05 and 0&#46;10&#44; respectively &#40;forward stepwise method with likelihood ratio statistics&#41;&#44; to select variables that were independent predictors of all-cause mortality&#46; Estimates of the association between predictors and endpoints are presented as hazard ratio &#40;HR&#41; and 95&#37; confidence interval &#40;CI&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">For all-cause mortality&#44; subgroup analysis was performed according to gender&#44; age &#40;&#60;70 years and &#8805;70 years&#41;&#44; presence or absence of diabetes&#44; STEMI vs&#46; NSTE-ACS&#44; and LVEF &#40;&#60;35&#37;&#44; 35-50&#37; and &#8805;50&#37;&#41;&#46; This categorization of LV function was used since it was the one available in our database&#59; specific LVEF values were not available for all patients&#46; Analysis of the interaction between beta-blocker therapy and each subgroup was performed using Cox regression models&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">IBM SPSS statistical software &#40;version 19&#46;0&#46;0&#46;2&#41; was used for all statistical analyses&#46; All statistical tests were two-sided with a value of 0&#46;05 for statistical significance&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">Of a total of 3536 patients included in our registry during the study period&#44; 83&#46;4&#37; received beta-blocker treatment&#46; After propensity-score matching&#44; 1520 patients were selected for analysis&#46; The population&#39;s characteristics were well balanced between groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#59; the absolute standardized difference of less than 10&#37; for all variables indicates adequate matching&#46; Patients&#8217; mean age was 66&#177;13 years&#44; most were male &#40;68&#37;&#41;&#44; and the most frequent diagnosis was STEMI &#40;61&#46;6&#37; of patients&#41;&#46; In patients who died very early in the course of admission&#44; before a complete echocardiogram was performed &#40;1&#46;3&#37;&#41;&#44; an admission echocardiogram or information from ventriculography was used to assess LV function&#46; Follow-up information was obtained in 99&#46;8&#37; of patients&#46; In-hospital&#44; 30-day and one-year mortality were 7&#46;5&#37;&#44; 8&#46;7&#37; and 11&#46;8&#37;&#44; respectively&#46; In this matched cohort&#44; patients who did not receive beta-blockers were also less likely to receive antiplatelet therapy&#44; angiotensin-converting enzyme inhibitors&#47;angiotensin receptor blockers &#40;ACEIs&#47;ARBs&#41;&#44; statins and revascularization &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Also&#44; all-cause mortality&#44; mechanical complications and cardiac arrest were significantly more frequent in patients not treated with beta-blockers&#46; The rate of complete AV block and stroke&#47;TIA was similar in both groups&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">In univariate Cox regression analysis&#44; the use of beta-blockers was associated with better outcome in the overall population &#40;HR 0&#46;34&#44; 95&#37; CI 0&#46;25-0&#46;45&#44; p&#60;0&#46;001&#41;&#46; In the multiple Cox proportional-hazards regression model&#44; the use of beta-blockers remained an independent predictor of better outcome&#44; together with the use of ACEIs&#47;ARBs &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Age&#44; heart rate&#44; systolic blood pressure&#44; diabetes&#44; LVEF&#44; ACEI&#47;ARB use&#44; renal function and mechanical complications were the other independent predictors of all-cause mortality in patients with ACS&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">In the subgroup analysis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#44; all subgroups had a better outcome with the use of beta-blockers&#44; including patients with normal or mildly to moderately reduced LVEF&#44; in both univariate and multivariate analysis&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Several trials and meta-analyses have demonstrated that beta-blockers reduce mortality and reinfarction by 20-25&#37; in those who have recovered from MI&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#8211;10</span></a> Over 52<span class="elsevierStyleHsp" style=""></span>000 patients were randomized in clinical trials studying beta-blockers in acute MI&#44; covering a range of beta-blockers&#44; and largely conducted in the pre-reperfusion era&#46; The available data at that time suggested trends toward reductions in mortality&#44; reinfarction and cardiac arrest&#44; if used in patients without contraindications&#46; A review of secondary prevention trials of beta-blocker therapy both in the acute phase and as secondary prevention showed an overall benefit&#44; with a relative risk reduction of 19&#37; in mortality&#44; particularly for secondary prevention &#40;23&#37; relative risk reduction&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> The Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction &#40;CAPRICORN&#41; trial definitively demonstrated the benefit of beta-blockers in patients with LV dysfunction &#40;LVEF &#60;40&#37;&#41; after MI with or without clinical signs of heart failure&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> However&#44; since the 1980s&#44; aspirin&#44; P2Y<span class="elsevierStyleInf">12</span> inhibitors&#44; thrombolysis followed by primary angioplasty&#44; high-dose statins&#44; enoxaparin&#44; mineralocorticoid receptor antagonists&#44; ACEIs&#44; implantable cardioverter-defibrillators&#44; and early revascularization for NSTE-ACS have all been introduced&#46; These changes in management were followed by dramatic decreases in mortality in the early 21st century in several registries&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#8211;17</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">COMMIT&#44; a large trial performed in the reperfusion era&#44; showed no difference in the rate of the composite endpoint of death&#44; reinfarction&#44; or cardiac arrest in the metoprolol group compared with the placebo group&#44; but significant reductions occurred in reinfarction and episodes of ventricular fibrillation&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> A meta-analysis that included earlier studies and low-risk patients from the COMMIT trial showed reductions of 13&#37; in all-cause mortality&#44; 22&#37; in reinfarction&#44; and 15&#37; in ventricular fibrillation or cardiac arrest&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> However&#44; in order to achieve these benefits safely&#44; it is important to avoid early administration of beta-blockers to patients with relative contraindications&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Another paper challenged the beneficial effect of beta-blockers after ACS&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> In an observational study with propensity-score matching&#44; with a median follow-up of 44 months in stable outpatients with and without coronary artery disease&#44; the use of beta-blockers was not associated with a lower risk of cardiovascular events &#40;primary outcome&#58; a composite of cardiovascular death&#44; nonfatal MI or nonfatal stroke&#59; secondary outcome&#58; the primary outcome plus hospitalization for atherothrombotic events or revascularization&#59; tertiary outcomes&#58; all-cause mortality&#44; cardiovascular mortality&#44; nonfatal MI&#44; nonfatal stroke&#44; and hospitalization separately&#41;&#44; including in the cohort with prior MI&#46; However&#44; in those with recent MI &#40;&#8804;1 year&#41;&#44; beta-blocker use was associated with a lower incidence of the secondary outcome &#40;odds ratio 0&#46;77&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In view of these uncertainties and contradictions and the limited evidence&#44; the purpose of our study was&#44; based on a real-world contemporary population of patients from an ACS registry&#44; to assess whether beta-blocker therapy is still beneficial&#44; on top of all guideline-recommended therapies&#46; We observed not only that the magnitude of benefit is highly significant&#44; with a relative risk reduction in one-year all-cause mortality of 56&#37;&#44; but also that this benefit is the same for STEMI and NSTE-ACS patients&#44; and most importantly is independent of LV function&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A recent study based on a UK registry showed that in survivors of hospitalization with MI who did not have heart failure or LV systolic dysfunction&#44; the use of beta-blockers was not associated with a lower risk of death up to one year&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> This result is clearly different from ours&#44; but their sample has different characteristics&#46; Ours had a predominance of patients with STEMI&#44; and Dondo et al&#46;&#8217;s study only included patients who survived to discharge&#46; Their main strength is that it has a very large sample of patients and also used propensity-score matching&#46; However&#44; the cutoff used for systolic dysfunction was LVEF &#60;30&#37;&#44; and they therefore included patients with normal and mildly and moderately impaired systolic function in the same analysis&#46; For this reason&#44; we also performed a substudy of patients who survived to discharge&#46; In those patients&#44; a tendency for some benefit was found for beta-blocker use in patients with LVEF 35-50&#37; &#40;HR 0&#46;46&#44; 95&#37; CI 0&#46;20-1&#46;06&#44; p&#61;0&#46;069&#41; and with LVEF &#62;50&#37; &#40;HR 0&#46;42&#44; 95&#37; CI 0&#46;18-0&#46;96&#44; p&#61;0&#46;036&#41;&#46; Surprisingly&#44; no benefit was found&#44; in terms of all-cause mortality at one-year follow-up&#44; in patients with LVEF &#60;35&#37; &#40;HR 0&#46;25&#44; 95&#37; CI 0&#46;05-1&#46;26&#44; p&#61;0&#46;09&#41; &#40;p&#61;0&#46;391 for the interaction&#41;&#46; However&#44; our study is clearly underpowered for this analysis&#44; particularly in the group with severe LV dysfunction&#46; Thus&#44; although our results are only partially in agreement with the findings of Dondo et al&#46;&#44; both studies can only be viewed as hypothesis-generating and the question should be addressed in larger studies&#44; preferably randomized clinical trials&#46; The different results in patients who survived to discharge highlight the importance of early implementation of beta-blockers&#44; which appear to have a major impact early in the course of disease&#44; independently of LV function&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In our population&#44; more patients in the beta-blocker group underwent percutaneous coronary intervention &#40;PCI&#41; than in the group without beta-blockers &#40;68&#46;0&#37; vs&#46; 80&#46;6&#37;&#41;&#46; This difference could be explained by the fact that STEMI was slightly more frequent in the beta-blocker group&#44; and coronary anatomy in NSTE-ACS is more often unsuitable for PCI&#46; Also&#44; aspirin and double antiplatelet therapy were used much less in patients not taking beta-blockers&#44; as were other drugs with significant impact on outcome&#44; such as ACEIs and statins&#46; This may be explained by the fact that in-hospital death was significantly more frequent and in some cases occurred very soon after admission &#40;in some cases before PCI&#41;&#59; the rate of major complications &#40;mechanical complications&#44; stroke&#47;TIA and major bleeding&#41; is another possible explanation for our findings&#44; because these complications might have precluded the use of some drugs&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Limitations</span><p id="par0175" class="elsevierStylePara elsevierViewall">This was an observational and non-randomized study&#46; However&#44; propensity-score matching enables the resulting limitations to be mitigated to some extent&#46; It was also a single-center study&#44; and so its findings may not be applicable to other populations with different baseline characteristics&#44; especially since our population had a predominance of STEMI cases&#44; which is not the case in many other centers&#46; Ours is a tertiary center with cases referred from many other hospitals in the region for urgent invasive treatment of ACS&#46; Thus&#44; some caution is advised when translating our findings to other cohorts&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">From our registry&#44; it was not possible to perform detailed analysis of the type and dosage of beta-blockers&#44; compliance with treatment over time&#44; or the reasons for not prescribing a beta-blocker&#46; Concerning the latter&#44; a study in the 1990s reported the presence of contraindications in 18&#37; of MI survivors&#44; the most common of which were bronchial asthma or chronic obstructive lung disease &#40;7&#37;&#41;&#44; heart failure controlled only by &#62;80 mg of furosemide daily or digoxin &#40;7&#37;&#41;&#44; sinus bradycardia &#40;4&#37;&#41;&#44; AV block &#40;5&#37;&#41; and hypotension &#40;5&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a> In that study&#44; only 51&#37; of MI survivors were discharged on a beta-blocker and although 82&#37; had no contraindication&#44; only 58&#37; of this group received a beta-blocker&#46; Moreover&#44; most patients received a significantly lower dosage than those shown to be effective in reducing mortality&#46; It is also important to remember that in the 1990s&#44; most available beta-blockers were not cardioselective&#46; A more recent study that analyzed the reasons recorded for not prescribing a beta-blocker &#40;with a rate of beta-blocker prescription after MI in the overall population of 80&#37;&#41; showed that half of the small number of patients who did not receive beta-blockers had contraindications&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> The rate of beta-blocker prescription in this study was similar to ours and thus only about 10&#37; of the overall population would be expected have contraindications&#44; which probably would not have affected our results&#46; Regarding compliance&#44; two recent papers showed that overall long-term compliance with beta-blockers is high &#8211; after one year&#44; the proportion of patients still on a beta-blocker had fallen by only 4&#37;&#44; with around 80&#37; of MI patients still taking the drug&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">23&#44;24</span></a> The same authors also report that if the medication is not prescribed at discharge it is highly unlikely to be prescribed later&#46; For this reason&#44; the lack of information on compliance probably does not significantly affect our results&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0185" class="elsevierStylePara elsevierViewall">Our study&#44; in a contemporary ACS population&#44; confirms that the benefits of beta-blocker use after ACS on top of all other guideline-recommended treatments are still significant&#44; particularly when prescribed early&#46; This is true not only in patients with LV dysfunction but also in patients with normal or mild to moderate LV dysfunction&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0190" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from any funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Resumo"
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              "titulo" => "Introdu&#231;&#227;o"
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              "titulo" => "M&#233;todos"
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              "titulo" => "Conclus&#245;es"
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          "titulo" => "Palavras-chave"
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          "titulo" => "Introduction"
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          "titulo" => "Discussion"
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          "titulo" => "Limitations"
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          "titulo" => "Conclusions"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-10-13"
    "fechaAceptado" => "2017-11-27"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1061243"
          "palabras" => array:3 [
            0 => "Beta-blockers"
            1 => "Myocardial infarction"
            2 => "Prognosis"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec1061242"
          "palabras" => array:3 [
            0 => "Bloqueadores-beta"
            1 => "Enfarte mioc&#225;rdio"
            2 => "Progn&#243;stico"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The evidence for beta-blocker use in patients after acute coronary syndrome &#40;ACS&#41;&#44; particularly in those with left ventricular &#40;LV&#41; dysfunction&#44; dates from the late 1990s&#46; We aimed to assess the role of beta-blockers in a contemporary population of patients with ACS&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Propensity-score matching &#40;1&#58;2&#41; was performed for the use of beta-blockers in a population of consecutive patients admitted to our department with ACS&#46; After matching&#44; 1520 patients were analyzed&#46; Cox regression analysis was used to assess the impact of beta-blocker use on the primary outcome &#40;one-year all-cause mortality&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients who did not receive beta-blockers were less aggressively treated with other pharmacological and invasive interventions and had higher one-year mortality &#40;20&#46;3&#37; vs&#46; 7&#46;5&#37;&#41;&#46; Beta-blocker use was an independent predictor of mortality&#44; with a significant relative risk reduction of 56&#37;&#46; The other independent predictors were age&#44; diabetes&#44; LV dysfunction&#44; heart rate&#44; systolic blood pressure and creatinine on admission&#46; The impact of beta-blockers was significant for all classes of LV function&#44; including patients with normal or mildly reduced ejection fraction&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In a contemporary ACS population&#44; we confirmed the benefits of beta-blocker use after ACS&#44; including in patients with normal or mildly to moderately impaired LV function&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A evid&#234;ncia para a utiliza&#231;&#227;o dos bloqueadores-beta em doentes ap&#243;s s&#237;ndrome coron&#225;ria aguda &#40;SCA&#41;&#44; particularmente em doentes com disfun&#231;&#227;o ventricular esquerda &#40;VE&#41; &#233; do final dos anos 90&#46; Foi nosso objetivo analisar o papel dos bloqueadores-beta numa popula&#231;&#227;o contempor&#226;nea de doentes com SCA&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foi realizado emparelhamento de <span class="elsevierStyleItalic">score</span> de propens&#227;o &#40;1&#58;2&#41; para a utiliza&#231;&#227;o de bloqueadores-beta numa popula&#231;&#227;o consecutiva de doentes admitidos no nosso servi&#231;o por SCA&#46; Ap&#243;s emparelhamento&#44; foram analisados 1520 doentes&#46; Foi utilizada a an&#225;lise de regress&#227;o de Cox para avaliar o impacto da utiliza&#231;&#227;o dos bloqueadores-beta na mortalidade de todas as causas a um ano de seguimento&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os doentes que n&#227;o receberam bloqueadores-beta foram tratados de forma menos agressiva com outras interven&#231;&#245;es farmacol&#243;gicas e invasivas e tiveram maior mortalidade a um ano &#40;20&#44;3&#37; <span class="elsevierStyleItalic">versus</span> 7&#44;5&#37;&#41;&#46; A utiliza&#231;&#227;o de bloqueadores-beta foi preditor independente de mortalidade com redu&#231;&#227;o significativa do risco relativo de 56&#37;&#46; Os restantes preditores independentes foram a idade&#44; diabetes&#44; disfun&#231;&#227;o VE&#44; frequ&#234;ncia card&#237;aca&#44; press&#227;o arterial sist&#243;lica e creatinina na admiss&#227;o&#46; O impacto dos bloqueadores-beta foi significativo em todas as classes de fun&#231;&#227;o VE&#44; incluindo doentes com fra&#231;&#227;o de eje&#231;&#227;o normal ou ligeiramente reduzida&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Numa popula&#231;&#227;o contempor&#226;nea de doentes com SCA&#44; confirm&#225;mos os benef&#237;cios da terap&#234;utica bloqueadora-beta ap&#243;s SCA&#44; incluindo em doentes com fun&#231;&#227;o VE normal ou com compromisso ligeiro a moderado&#46;</p></span>"
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              0 => array:2 [
                "termino" => "ACEI"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">angiotensin-converting enzyme inhibitor</p>"
              ]
              1 => array:2 [
                "termino" => "ACS"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">acute coronary syndrome</p>"
              ]
              2 => array:2 [
                "termino" => "ARB"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">angiotensin receptor blocker</p>"
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              3 => array:2 [
                "termino" => "AV"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">atrioventricular</p>"
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              4 => array:2 [
                "termino" => "CABG"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">coronary artery bypass grafting</p>"
              ]
              5 => array:2 [
                "termino" => "CI"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">confidence interval</p>"
              ]
              6 => array:2 [
                "termino" => "HR"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">hazard ratio</p>"
              ]
              7 => array:2 [
                "termino" => "LV"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">left ventricular</p>"
              ]
              8 => array:2 [
                "termino" => "LVEF"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">left ventricular ejection fraction</p>"
              ]
              9 => array:2 [
                "termino" => "NSTE-ACS"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">non-ST-elevation acute coronary syndrome</p>"
              ]
              10 => array:2 [
                "termino" => "PCI"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">percutaneous coronary intervention</p>"
              ]
              11 => array:2 [
                "termino" => "STEMI"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">ST-elevation myocardial infarction</p>"
              ]
              12 => array:2 [
                "termino" => "TIA"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">transient ischemic attack</p>"
              ]
            ]
          ]
        ]
      ]
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier survival curve comparing patients with and without beta-blocker therapy&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Subgroup analysis&#46; CI&#58; confidence interval&#59; HR&#58; hazard ratio&#59; LVEF&#58; left ventricular ejection fraction&#59; NSTE-ACS&#58; non-ST-elevation acute coronary syndrome&#59; STEMI&#58; ST-elevation myocardial infarction&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">bpm&#58; beats per minute&#59; CABG&#58; coronary artery bypass grafting&#59; MI&#58; myocardial infarction&#59; PCI&#58; percutaneous coronary intervention&#59; SBP&#58; systolic blood pressure&#59; STEMI&#58; ST-elevation myocardial infarction&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No beta-blocker therapy &#40;n&#61;507&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Beta-blocker therapy &#40;n&#61;1013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;914&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male gender&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;901&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Risk factors&#44; &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;937&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hyperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;636&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;274&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;903&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Previous history&#44; &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous revascularization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;798&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Initial presentation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart rate&#44; bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;783&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SBP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;651&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Killip class &#62;I&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;599&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Killip class IV&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>STEMI&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;057&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinine&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No beta-blocker therapy &#40;n&#61;507&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Aspirin&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">DAPT&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ACEI&#47;ARB&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CABG&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Revascularization</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Complete AV block&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LVEF&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;970&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>35-50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mechanical complications&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Stroke&#47;TIA&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;099&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Major bleeding&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">In-hospital mortality&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">30-day mortality&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">One-year mortality&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;per 10-year increase&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;07 &#40;1&#46;54-2&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;99 &#40;1&#46;44-2&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">STEMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;31 &#40;0&#46;96-1&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart rate &#40;per 10-bpm increase&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;33 &#40;1&#46;26-1&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;17 &#40;1&#46;09-1&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP &#40;per 10-mmHg increase&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;87 &#40;0&#46;82-0&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;92 &#40;0&#46;86-0&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;82 &#40;2&#46;82-5&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;76 &#40;2&#46;31-3&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;84 &#40;1&#46;49-2&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;34 &#40;1&#46;24-1&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;27 &#40;1&#46;13-1&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DAPT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;51 &#40;0&#46;34-0&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACEI&#47;ARB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;32 &#40;0&#46;24-0&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;52 &#40;0&#46;35-0&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Beta-blocker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34 &#40;0&#46;25-0&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;44 &#40;0&#46;31-0&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Statin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38 &#40;0&#46;27-0&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
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Original Article
What is the role of beta-blockers in a contemporary treatment cohort of patients with acute coronary syndrome? A propensity-score matching analysis
Qual o papel dos bloqueadores-beta numa coorte de tratamento contemporânea de doentes com síndrome coronária aguda? Análise de emparelhamento de score de propensão
Ana Teresa Timóteoa,b,
Corresponding author
ana_timoteo@yahoo.com

Corresponding author.
, Sílvia Aguiar Rosaa,b, Madalena Cruza, Rita Ilhão Moreiraa, Ramiro Carvalhoa, Maria Lurdes Ferreiraa, Rui Cruz Ferreiraa,b
a Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Lisbon, Portugal
b NOVA Medical School, Lisbon, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0070" class="elsevierStylePara elsevierViewall">The role of beta-blockers is clearly established for secondary prevention in all current guidelines for the management of patients with acute coronary syndromes &#40;ACS&#41;&#44; particularly in the presence of left ventricular &#40;LV&#41; dysfunction&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#44;2</span></a> Beta-blockers improve outcome in coronary artery disease by reducing oxygen demand and hence ischemia&#44; attenuating ventricular remodeling&#44; and preventing lethal arrhythmias and sudden death&#46; However&#44; the majority of studies that support these effects were performed between the 1970s and the 1990s&#44; before major advances in therapy such as the introduction of reperfusion therapy and modern pharmacotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#8211;10</span></a> Beta-blockers have not been investigated in contemporary trials&#44; although it is not unreasonable to extrapolate their benefits to this setting&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Each successive intervention that reduces risk reduces the absolute benefit of further interventions&#46; Dramatic decreases in mortality were observed in the early 21st century in several ACS registries&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#8211;17</span></a> As the baseline risk of a population decreases due to a new intervention&#44; the incremental benefit of previous interventions needs to be re-evaluated&#46; Currently&#44; most ACS patients are discharged without significant residual ischemia&#44; and the risk of lethal arrhythmias is extremely low because remodeling and even quite large reductions in LV ejection fraction &#40;LVEF&#41; with heart failure are not a significant problem with contemporary treatment&#46; A more recent study in stable CAD patients challenged the use of beta-blockers&#44; further reinforcing the need for reassessment of their benefit in a contemporary cohort of patients with ACS&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> Also&#44; current guidelines do not provide a definite recommendation for the use of beta-blockers in patients with ACS and normal or mildly reduced LVEF &#40;&#8805;40&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">It was our objective to assess the role of beta-blockers in a contemporary population of patients with ACS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0085" class="elsevierStylePara elsevierViewall">All consecutive adult patients &#40;aged &#8805;18 years&#41; admitted to our intensive care unit with ACS were prospectively included in our center&#39;s ACS registry between January 2005 and November 2015 and were included in the present study&#46; Criteria for inclusion were a history of chest pain at rest or other symptoms suggestive of ACS &#40;the most recent episode within 48 hours of admission&#41; with or without new or presumed new significant ST-segment or T-wave changes&#44; new left bundle branch block and elevated biomarkers of myocardial damage with a rise and&#47;or fall in levels&#46; Myocardial infarction &#40;MI&#41; was defined according to the universal definition of type 1 MI&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> A diagnosis of ST-elevation MI &#40;STEMI&#41; was made in the presence of persistent &#40;&#62;30 min&#41; ST-segment elevation&#46; All other cases were considered non-ST elevation ACS &#40;NSTE-ACS&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Data were collected in a dedicated electronic database&#44; and included demographic&#44; clinical and patient-management related characteristics&#44; as well as clinical outcome&#46; Hypertension&#44; diabetes and hyperlipidemia were defined as either previously known or on specific therapy&#46; If patients had smoked during the previous six months they were classified as smokers and were self-reported&#46; Decisions on patient management strategy&#44; including referral for coronary angiography and mode of myocardial revascularization&#44; if any&#44; were at the discretion of the attending physician&#46; LVEF was obtained before discharge by echocardiography&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Follow-up was obtained for every patient who survived to discharge by reviewing medical records and&#47;or by telephone interview with the patient or family members&#46; The primary endpoint was all-cause mortality at one-year follow-up&#46; In-hospital secondary endpoints were cardiac arrest&#44; complete atrioventricular &#40;AV&#41; block&#44; mechanical complications&#44; stroke&#47;transient ischemic attack &#40;TIA&#41;&#44; LV function&#44; major bleeding &#40;according to the Global Use of Strategies to Open Occluded Coronary Arteries &#91;GUSTO&#93; criteria&#41;&#44; and all-cause mortality during the index hospitalization and at 30-day follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">All procedures contributing to this work comply with the ethical standards of the 1975 Helsinki Declaration&#46; This research does not involve human or animal experimentation&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0105" class="elsevierStylePara elsevierViewall">Continuous variables are reported as means and standard deviation and were compared with the Student&#39;s t test&#46; Normality tests were performed with the Kolmogorov-Smirnov test and homogeneity of variance was tested with Levene&#39;s test&#46; Continuous variables without normal distribution are reported as medians and interquartile range and were compared with the Mann-Whitney test&#46; Categorical variables are reported as percentages and differences between groups were tested with the chi-square test or Fischer&#39;s exact test&#44; as appropriate&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Propensity-score matching was performed to adjust for the non-randomized assignment of patients to treatment and for the potential bias due to differences between the study groups&#46; Propensity scoring helps deal with bias arising from confounding by indication&#44; enabling a more accurate comparison of outcomes between participants with similar propensity scores based on the set of available information about that individual&#46; A propensity score was calculated for each participant by logistic regression as the likelihood of being assigned to treatment with a beta-blocker&#46; The model included all variables that in the logistic analysis had a p-value &#60;0&#46;05&#46; A 1&#58;2 matched analysis was then performed on the basis of each patient&#39;s estimated propensity score&#46; Baseline and in-hospital characteristics were then compared&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Estimates of event-free survival at one-year follow-up were calculated by the Kaplan-Meier method and survival curves were compared with the log-rank test&#46; A Cox proportional-hazards regression model was used with the p level for entry into and removal from the model set at 0&#46;05 and 0&#46;10&#44; respectively &#40;forward stepwise method with likelihood ratio statistics&#41;&#44; to select variables that were independent predictors of all-cause mortality&#46; Estimates of the association between predictors and endpoints are presented as hazard ratio &#40;HR&#41; and 95&#37; confidence interval &#40;CI&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">For all-cause mortality&#44; subgroup analysis was performed according to gender&#44; age &#40;&#60;70 years and &#8805;70 years&#41;&#44; presence or absence of diabetes&#44; STEMI vs&#46; NSTE-ACS&#44; and LVEF &#40;&#60;35&#37;&#44; 35-50&#37; and &#8805;50&#37;&#41;&#46; This categorization of LV function was used since it was the one available in our database&#59; specific LVEF values were not available for all patients&#46; Analysis of the interaction between beta-blocker therapy and each subgroup was performed using Cox regression models&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">IBM SPSS statistical software &#40;version 19&#46;0&#46;0&#46;2&#41; was used for all statistical analyses&#46; All statistical tests were two-sided with a value of 0&#46;05 for statistical significance&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">Of a total of 3536 patients included in our registry during the study period&#44; 83&#46;4&#37; received beta-blocker treatment&#46; After propensity-score matching&#44; 1520 patients were selected for analysis&#46; The population&#39;s characteristics were well balanced between groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#59; the absolute standardized difference of less than 10&#37; for all variables indicates adequate matching&#46; Patients&#8217; mean age was 66&#177;13 years&#44; most were male &#40;68&#37;&#41;&#44; and the most frequent diagnosis was STEMI &#40;61&#46;6&#37; of patients&#41;&#46; In patients who died very early in the course of admission&#44; before a complete echocardiogram was performed &#40;1&#46;3&#37;&#41;&#44; an admission echocardiogram or information from ventriculography was used to assess LV function&#46; Follow-up information was obtained in 99&#46;8&#37; of patients&#46; In-hospital&#44; 30-day and one-year mortality were 7&#46;5&#37;&#44; 8&#46;7&#37; and 11&#46;8&#37;&#44; respectively&#46; In this matched cohort&#44; patients who did not receive beta-blockers were also less likely to receive antiplatelet therapy&#44; angiotensin-converting enzyme inhibitors&#47;angiotensin receptor blockers &#40;ACEIs&#47;ARBs&#41;&#44; statins and revascularization &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Also&#44; all-cause mortality&#44; mechanical complications and cardiac arrest were significantly more frequent in patients not treated with beta-blockers&#46; The rate of complete AV block and stroke&#47;TIA was similar in both groups&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">In univariate Cox regression analysis&#44; the use of beta-blockers was associated with better outcome in the overall population &#40;HR 0&#46;34&#44; 95&#37; CI 0&#46;25-0&#46;45&#44; p&#60;0&#46;001&#41;&#46; In the multiple Cox proportional-hazards regression model&#44; the use of beta-blockers remained an independent predictor of better outcome&#44; together with the use of ACEIs&#47;ARBs &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Age&#44; heart rate&#44; systolic blood pressure&#44; diabetes&#44; LVEF&#44; ACEI&#47;ARB use&#44; renal function and mechanical complications were the other independent predictors of all-cause mortality in patients with ACS&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">In the subgroup analysis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#44; all subgroups had a better outcome with the use of beta-blockers&#44; including patients with normal or mildly to moderately reduced LVEF&#44; in both univariate and multivariate analysis&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Several trials and meta-analyses have demonstrated that beta-blockers reduce mortality and reinfarction by 20-25&#37; in those who have recovered from MI&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#8211;10</span></a> Over 52<span class="elsevierStyleHsp" style=""></span>000 patients were randomized in clinical trials studying beta-blockers in acute MI&#44; covering a range of beta-blockers&#44; and largely conducted in the pre-reperfusion era&#46; The available data at that time suggested trends toward reductions in mortality&#44; reinfarction and cardiac arrest&#44; if used in patients without contraindications&#46; A review of secondary prevention trials of beta-blocker therapy both in the acute phase and as secondary prevention showed an overall benefit&#44; with a relative risk reduction of 19&#37; in mortality&#44; particularly for secondary prevention &#40;23&#37; relative risk reduction&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> The Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction &#40;CAPRICORN&#41; trial definitively demonstrated the benefit of beta-blockers in patients with LV dysfunction &#40;LVEF &#60;40&#37;&#41; after MI with or without clinical signs of heart failure&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> However&#44; since the 1980s&#44; aspirin&#44; P2Y<span class="elsevierStyleInf">12</span> inhibitors&#44; thrombolysis followed by primary angioplasty&#44; high-dose statins&#44; enoxaparin&#44; mineralocorticoid receptor antagonists&#44; ACEIs&#44; implantable cardioverter-defibrillators&#44; and early revascularization for NSTE-ACS have all been introduced&#46; These changes in management were followed by dramatic decreases in mortality in the early 21st century in several registries&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#8211;17</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">COMMIT&#44; a large trial performed in the reperfusion era&#44; showed no difference in the rate of the composite endpoint of death&#44; reinfarction&#44; or cardiac arrest in the metoprolol group compared with the placebo group&#44; but significant reductions occurred in reinfarction and episodes of ventricular fibrillation&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> A meta-analysis that included earlier studies and low-risk patients from the COMMIT trial showed reductions of 13&#37; in all-cause mortality&#44; 22&#37; in reinfarction&#44; and 15&#37; in ventricular fibrillation or cardiac arrest&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> However&#44; in order to achieve these benefits safely&#44; it is important to avoid early administration of beta-blockers to patients with relative contraindications&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Another paper challenged the beneficial effect of beta-blockers after ACS&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> In an observational study with propensity-score matching&#44; with a median follow-up of 44 months in stable outpatients with and without coronary artery disease&#44; the use of beta-blockers was not associated with a lower risk of cardiovascular events &#40;primary outcome&#58; a composite of cardiovascular death&#44; nonfatal MI or nonfatal stroke&#59; secondary outcome&#58; the primary outcome plus hospitalization for atherothrombotic events or revascularization&#59; tertiary outcomes&#58; all-cause mortality&#44; cardiovascular mortality&#44; nonfatal MI&#44; nonfatal stroke&#44; and hospitalization separately&#41;&#44; including in the cohort with prior MI&#46; However&#44; in those with recent MI &#40;&#8804;1 year&#41;&#44; beta-blocker use was associated with a lower incidence of the secondary outcome &#40;odds ratio 0&#46;77&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In view of these uncertainties and contradictions and the limited evidence&#44; the purpose of our study was&#44; based on a real-world contemporary population of patients from an ACS registry&#44; to assess whether beta-blocker therapy is still beneficial&#44; on top of all guideline-recommended therapies&#46; We observed not only that the magnitude of benefit is highly significant&#44; with a relative risk reduction in one-year all-cause mortality of 56&#37;&#44; but also that this benefit is the same for STEMI and NSTE-ACS patients&#44; and most importantly is independent of LV function&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A recent study based on a UK registry showed that in survivors of hospitalization with MI who did not have heart failure or LV systolic dysfunction&#44; the use of beta-blockers was not associated with a lower risk of death up to one year&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> This result is clearly different from ours&#44; but their sample has different characteristics&#46; Ours had a predominance of patients with STEMI&#44; and Dondo et al&#46;&#8217;s study only included patients who survived to discharge&#46; Their main strength is that it has a very large sample of patients and also used propensity-score matching&#46; However&#44; the cutoff used for systolic dysfunction was LVEF &#60;30&#37;&#44; and they therefore included patients with normal and mildly and moderately impaired systolic function in the same analysis&#46; For this reason&#44; we also performed a substudy of patients who survived to discharge&#46; In those patients&#44; a tendency for some benefit was found for beta-blocker use in patients with LVEF 35-50&#37; &#40;HR 0&#46;46&#44; 95&#37; CI 0&#46;20-1&#46;06&#44; p&#61;0&#46;069&#41; and with LVEF &#62;50&#37; &#40;HR 0&#46;42&#44; 95&#37; CI 0&#46;18-0&#46;96&#44; p&#61;0&#46;036&#41;&#46; Surprisingly&#44; no benefit was found&#44; in terms of all-cause mortality at one-year follow-up&#44; in patients with LVEF &#60;35&#37; &#40;HR 0&#46;25&#44; 95&#37; CI 0&#46;05-1&#46;26&#44; p&#61;0&#46;09&#41; &#40;p&#61;0&#46;391 for the interaction&#41;&#46; However&#44; our study is clearly underpowered for this analysis&#44; particularly in the group with severe LV dysfunction&#46; Thus&#44; although our results are only partially in agreement with the findings of Dondo et al&#46;&#44; both studies can only be viewed as hypothesis-generating and the question should be addressed in larger studies&#44; preferably randomized clinical trials&#46; The different results in patients who survived to discharge highlight the importance of early implementation of beta-blockers&#44; which appear to have a major impact early in the course of disease&#44; independently of LV function&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In our population&#44; more patients in the beta-blocker group underwent percutaneous coronary intervention &#40;PCI&#41; than in the group without beta-blockers &#40;68&#46;0&#37; vs&#46; 80&#46;6&#37;&#41;&#46; This difference could be explained by the fact that STEMI was slightly more frequent in the beta-blocker group&#44; and coronary anatomy in NSTE-ACS is more often unsuitable for PCI&#46; Also&#44; aspirin and double antiplatelet therapy were used much less in patients not taking beta-blockers&#44; as were other drugs with significant impact on outcome&#44; such as ACEIs and statins&#46; This may be explained by the fact that in-hospital death was significantly more frequent and in some cases occurred very soon after admission &#40;in some cases before PCI&#41;&#59; the rate of major complications &#40;mechanical complications&#44; stroke&#47;TIA and major bleeding&#41; is another possible explanation for our findings&#44; because these complications might have precluded the use of some drugs&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Limitations</span><p id="par0175" class="elsevierStylePara elsevierViewall">This was an observational and non-randomized study&#46; However&#44; propensity-score matching enables the resulting limitations to be mitigated to some extent&#46; It was also a single-center study&#44; and so its findings may not be applicable to other populations with different baseline characteristics&#44; especially since our population had a predominance of STEMI cases&#44; which is not the case in many other centers&#46; Ours is a tertiary center with cases referred from many other hospitals in the region for urgent invasive treatment of ACS&#46; Thus&#44; some caution is advised when translating our findings to other cohorts&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">From our registry&#44; it was not possible to perform detailed analysis of the type and dosage of beta-blockers&#44; compliance with treatment over time&#44; or the reasons for not prescribing a beta-blocker&#46; Concerning the latter&#44; a study in the 1990s reported the presence of contraindications in 18&#37; of MI survivors&#44; the most common of which were bronchial asthma or chronic obstructive lung disease &#40;7&#37;&#41;&#44; heart failure controlled only by &#62;80 mg of furosemide daily or digoxin &#40;7&#37;&#41;&#44; sinus bradycardia &#40;4&#37;&#41;&#44; AV block &#40;5&#37;&#41; and hypotension &#40;5&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a> In that study&#44; only 51&#37; of MI survivors were discharged on a beta-blocker and although 82&#37; had no contraindication&#44; only 58&#37; of this group received a beta-blocker&#46; Moreover&#44; most patients received a significantly lower dosage than those shown to be effective in reducing mortality&#46; It is also important to remember that in the 1990s&#44; most available beta-blockers were not cardioselective&#46; A more recent study that analyzed the reasons recorded for not prescribing a beta-blocker &#40;with a rate of beta-blocker prescription after MI in the overall population of 80&#37;&#41; showed that half of the small number of patients who did not receive beta-blockers had contraindications&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> The rate of beta-blocker prescription in this study was similar to ours and thus only about 10&#37; of the overall population would be expected have contraindications&#44; which probably would not have affected our results&#46; Regarding compliance&#44; two recent papers showed that overall long-term compliance with beta-blockers is high &#8211; after one year&#44; the proportion of patients still on a beta-blocker had fallen by only 4&#37;&#44; with around 80&#37; of MI patients still taking the drug&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">23&#44;24</span></a> The same authors also report that if the medication is not prescribed at discharge it is highly unlikely to be prescribed later&#46; For this reason&#44; the lack of information on compliance probably does not significantly affect our results&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0185" class="elsevierStylePara elsevierViewall">Our study&#44; in a contemporary ACS population&#44; confirms that the benefits of beta-blocker use after ACS on top of all other guideline-recommended treatments are still significant&#44; particularly when prescribed early&#46; This is true not only in patients with LV dysfunction but also in patients with normal or mild to moderate LV dysfunction&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0190" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from any funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The evidence for beta-blocker use in patients after acute coronary syndrome &#40;ACS&#41;&#44; particularly in those with left ventricular &#40;LV&#41; dysfunction&#44; dates from the late 1990s&#46; We aimed to assess the role of beta-blockers in a contemporary population of patients with ACS&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Propensity-score matching &#40;1&#58;2&#41; was performed for the use of beta-blockers in a population of consecutive patients admitted to our department with ACS&#46; After matching&#44; 1520 patients were analyzed&#46; Cox regression analysis was used to assess the impact of beta-blocker use on the primary outcome &#40;one-year all-cause mortality&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients who did not receive beta-blockers were less aggressively treated with other pharmacological and invasive interventions and had higher one-year mortality &#40;20&#46;3&#37; vs&#46; 7&#46;5&#37;&#41;&#46; Beta-blocker use was an independent predictor of mortality&#44; with a significant relative risk reduction of 56&#37;&#46; The other independent predictors were age&#44; diabetes&#44; LV dysfunction&#44; heart rate&#44; systolic blood pressure and creatinine on admission&#46; The impact of beta-blockers was significant for all classes of LV function&#44; including patients with normal or mildly reduced ejection fraction&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In a contemporary ACS population&#44; we confirmed the benefits of beta-blocker use after ACS&#44; including in patients with normal or mildly to moderately impaired LV function&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A evid&#234;ncia para a utiliza&#231;&#227;o dos bloqueadores-beta em doentes ap&#243;s s&#237;ndrome coron&#225;ria aguda &#40;SCA&#41;&#44; particularmente em doentes com disfun&#231;&#227;o ventricular esquerda &#40;VE&#41; &#233; do final dos anos 90&#46; Foi nosso objetivo analisar o papel dos bloqueadores-beta numa popula&#231;&#227;o contempor&#226;nea de doentes com SCA&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foi realizado emparelhamento de <span class="elsevierStyleItalic">score</span> de propens&#227;o &#40;1&#58;2&#41; para a utiliza&#231;&#227;o de bloqueadores-beta numa popula&#231;&#227;o consecutiva de doentes admitidos no nosso servi&#231;o por SCA&#46; Ap&#243;s emparelhamento&#44; foram analisados 1520 doentes&#46; Foi utilizada a an&#225;lise de regress&#227;o de Cox para avaliar o impacto da utiliza&#231;&#227;o dos bloqueadores-beta na mortalidade de todas as causas a um ano de seguimento&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os doentes que n&#227;o receberam bloqueadores-beta foram tratados de forma menos agressiva com outras interven&#231;&#245;es farmacol&#243;gicas e invasivas e tiveram maior mortalidade a um ano &#40;20&#44;3&#37; <span class="elsevierStyleItalic">versus</span> 7&#44;5&#37;&#41;&#46; A utiliza&#231;&#227;o de bloqueadores-beta foi preditor independente de mortalidade com redu&#231;&#227;o significativa do risco relativo de 56&#37;&#46; Os restantes preditores independentes foram a idade&#44; diabetes&#44; disfun&#231;&#227;o VE&#44; frequ&#234;ncia card&#237;aca&#44; press&#227;o arterial sist&#243;lica e creatinina na admiss&#227;o&#46; O impacto dos bloqueadores-beta foi significativo em todas as classes de fun&#231;&#227;o VE&#44; incluindo doentes com fra&#231;&#227;o de eje&#231;&#227;o normal ou ligeiramente reduzida&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Numa popula&#231;&#227;o contempor&#226;nea de doentes com SCA&#44; confirm&#225;mos os benef&#237;cios da terap&#234;utica bloqueadora-beta ap&#243;s SCA&#44; incluindo em doentes com fun&#231;&#227;o VE normal ou com compromisso ligeiro a moderado&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:13 [
              0 => array:2 [
                "termino" => "ACEI"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">angiotensin-converting enzyme inhibitor</p>"
              ]
              1 => array:2 [
                "termino" => "ACS"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">acute coronary syndrome</p>"
              ]
              2 => array:2 [
                "termino" => "ARB"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">angiotensin receptor blocker</p>"
              ]
              3 => array:2 [
                "termino" => "AV"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">atrioventricular</p>"
              ]
              4 => array:2 [
                "termino" => "CABG"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">coronary artery bypass grafting</p>"
              ]
              5 => array:2 [
                "termino" => "CI"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">confidence interval</p>"
              ]
              6 => array:2 [
                "termino" => "HR"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">hazard ratio</p>"
              ]
              7 => array:2 [
                "termino" => "LV"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">left ventricular</p>"
              ]
              8 => array:2 [
                "termino" => "LVEF"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">left ventricular ejection fraction</p>"
              ]
              9 => array:2 [
                "termino" => "NSTE-ACS"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">non-ST-elevation acute coronary syndrome</p>"
              ]
              10 => array:2 [
                "termino" => "PCI"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">percutaneous coronary intervention</p>"
              ]
              11 => array:2 [
                "termino" => "STEMI"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">ST-elevation myocardial infarction</p>"
              ]
              12 => array:2 [
                "termino" => "TIA"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">transient ischemic attack</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1489
            "Ancho" => 2167
            "Tamanyo" => 85960
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier survival curve comparing patients with and without beta-blocker therapy&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 981
            "Ancho" => 2500
            "Tamanyo" => 147265
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Subgroup analysis&#46; CI&#58; confidence interval&#59; HR&#58; hazard ratio&#59; LVEF&#58; left ventricular ejection fraction&#59; NSTE-ACS&#58; non-ST-elevation acute coronary syndrome&#59; STEMI&#58; ST-elevation myocardial infarction&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">bpm&#58; beats per minute&#59; CABG&#58; coronary artery bypass grafting&#59; MI&#58; myocardial infarction&#59; PCI&#58; percutaneous coronary intervention&#59; SBP&#58; systolic blood pressure&#59; STEMI&#58; ST-elevation myocardial infarction&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No beta-blocker therapy &#40;n&#61;507&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Beta-blocker therapy &#40;n&#61;1013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;914&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male gender&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;901&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Risk factors&#44; &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;937&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hyperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;636&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;274&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;903&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Previous history&#44; &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous revascularization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;798&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Initial presentation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart rate&#44; bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;783&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SBP&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;651&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Killip class &#62;I&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;599&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Killip class IV&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>STEMI&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;057&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinine&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No beta-blocker therapy &#40;n&#61;507&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Beta-blocker therapy &#40;n&#61;1013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Aspirin&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">DAPT&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ACEI&#47;ARB&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Statin&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">PCI&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CABG&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Revascularization</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cardiac arrest&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Complete AV block&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">LVEF&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;970&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>35-50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mechanical complications&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Stroke&#47;TIA&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;099&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">In-hospital mortality&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">30-day mortality&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">One-year mortality&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;03 &#40;1&#46;72-2&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;59 &#40;0&#46;44-0&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;07 &#40;1&#46;54-2&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;99 &#40;1&#46;44-2&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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ISSN: 21742049
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Revista Portuguesa de Cardiologia (English edition)
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