Abstract 4146402: The efficacy and safety of β-blockers in patients with Chronic Obstructive Pulmonary Disease after Myocardial Infarction: a Systematic review and Meta-analysis.

Background: Previous clinical trials demonstrated the efficacy of beta-blockers (BB) after myocardial infarction (MI). However, the effects and safety of BB in patients with chronic obstructive pulmonary disease(COPD) after MI remain a mystery. Therefore, we conducted a systematic review and meta-analysis evaluating beta-blocker use after MI in patients with COPD. Methods: We performed a systematic review and meta-analysis of observational studies that included patients with COPD who received BB after an episode of MI. We searched through Pubmed, Cochrane, and Embase databases. Our primary efficacy outcome was (1) all-cause mortality, and our safety outcome was (2) COPD-related and respiratory adverse events. In our secondary analysis, we evaluated all-cause mortality in patients with a prior history of heart failure (HF). Statistical analysis was done using R Studio 4.3.2. Results: A total of 6 studies were included, encompassing 41840 patients, of whom 16561 (39.5%) were in the beta-blocker group. Most of the participants were male (65%) and the mean follow-up was 5.1 years. In the pooled analysis, all-cause mortality was significantly lower in the BB group (HR 0.81; 95% CI 0.66, 0.98; p = 0.03, Fig 1A). Our secondary analysis in the HF subgroup also showed a significant risk reduction in all-cause mortality(HR 0.80; 95% CI 0.66, 0.97; p = 0.02, Fig 1B.) Regarding COPD-related and respiratory adverse events, the analysis demonstrated a significantly lower incidence in the BB group (HR 0.79; 95% CI 0.74, 0.83; p<0.01; Fig 2 ). Conclusion: In this meta-analysis involving COPD patients following recent MI, BB utilization was linked to reduced all-cause mortality and a decreased risk of COPD-related adverse events. Additionally, BB administration was correlated with reduced all-cause mortality within the HF subgroup of this cohort.