Selection of β‐Blocker in Patients With Cirrhosis and Acute Myocardial Infarction: A 13‐Year Nationwide Population‐Based Study in Asia

BACKGROUND: It is not clear whether β(1)‐selective or nonselective β‐blockers should be used in patients with cirrhosis and acute myocardial infarction. METHODS AND RESULTS: Medical records were retrieved from Taiwan NHIRD (National Health Insurance Research Database) during 2001‐2013. Patients were excluded for age <20, previous acute myocardial infarction, contraindication to β‐blockers, chronic obstructive pulmonary disease, asthma, or atrioventricular conduction disease. Patients who died during index admission, had a follow‐up <6 months, had a medication ratio of either β(1)‐selective or nonselective β‐blocker <80%, or who switched between β‐blockers were also excluded. Patients on β(1)‐selective blockers and nonselective β‐blockers were propensity score matched and compared for outcome. Primary outcomes were 1‐ and 2‐year cardiovascular events, liver adverse outcomes, and all‐cause mortality. A total of 203 595 patients with acute myocardial infarction were enrolled, of whom 6355 had cirrhosis. After screening for exclusion criteria, 1769 patients (655 patients on β‐blockers and 1114 patients not on β‐blockers) were eligible for analysis. Among patients on β‐blockers, propensity score matching was performed, and 218 patients on β(1)‐selective blockers and 218 patients on nonselective β‐blockers were studied. During a 2‐year follow‐up, patients on β(1)‐selective blockers had significantly fewer major cardiac and cerebrovascular events (hazard ratio=0.62; 95% confidence interval=0.42‐0.91; P=0.014), a trend toward lower all‐cause mortality (hazard ratio=0.66; 95% confidence interval=0.38‐1.14; P=0.135), and nonworsening liver outcome (hazard ratio=0.66; 95% confidence interval=0.38‐1.14; P=0.354). CONCLUSIONS: In patients with cirrhosis and acute myocardial infarction, selecting a β‐blocker is a clinical dilemma. Our study showed that the use of β(1)‐selective blockers is associated with lower risks of major cardiac and cerebrovascular events.