Beta-blockers after myocardial infarction: effects according to sex in the REBOOT trial.

Whether these recent findings apply equally to women and men remains unknown.

这些最近的研究发现是否同样适用于女性和男性，目前尚不清楚。

Methods

Using data from REBOOT (tREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fracTion), the largest randomized trial evaluating the effect of beta-blockers after acute MI with LVEF > 40%, a pre-specified sex-specific subgroup analysis was performed.

使用来自REBOOT（REBOOT，即“急性心肌梗死后使用β受体阻滞剂治疗，无射血分数降低”）的数据，这是评估急性心肌梗死后（LVEF > 40%）使用β受体阻滞剂效果的最大规模随机试验，进行了预先设定的性别特定的亚组分析。

A total of 8438 out of the 8505 randomized patients comprised the intention-to-treatpopulation.

共有8438名患者，占随机入组的8505名患者总数，构成了意向治疗人群。

Results

Among 8438 patients, 1627 were women, who were older, had more comorbidities, and received fewer guideline-based therapies than men.

在8438名患者中，有1627名女性，她们比男性年龄大，患有更多合并症，并且接受的基于指南的治疗较少。

Over a median follow-up of 3.7 years, women had overall higher rates of the primary composite outcome (death, MI, or heart failure hospitalization) than men.

在中位随访3.7年的时间里，女性的整体主要复合结果（死亡、心肌梗死或心力衰竭住院）的发生率高于男性。

The incidencerate of the primary endpoint in women was 30.4 and 21.0/1000 patient-years in the beta-blocker group and no beta-blocker group, respectively (hazard ratio1.45, 95% confidence interval1.04-2.03).

在女性患者中，主要终点事件的发生率在使用β受体阻滞剂组和未使用β受体阻滞剂组分别为30.4和21.0/1000患者年（风险比1.45，95%置信区间1.04-2.03）。

No significant differences were observed in men (hazard ratio.94, 95% confidence interval.79-1.13; P for interaction = .026).

在男性患者中未观察到显著差异（风险比0.94，95%置信区间0.79-1.13；交互作用P值=0.026）。

The excess risk in women was mainly driven by increased mortality and was most evident among those with preserved LVEF (P for interaction = .030) and those receiving higher beta-blocker doses (P for interaction = .045).

女性的超额风险主要由死亡率增加所驱动，这在那些左心室射血分数(LVEF)保持良好的女性中最为明显（交互作用P值=0.030），以及那些接受更高剂量β受体阻滞剂治疗的女性中（交互作用P值=0.045）。

Conclusions

In the REBOOT trial of MI patients managed according to contemporary standards, beta-blocker therapy was associated with evidence of harm in women-particularly those with preserved LVEF and receiving higher doses-an effect not observed in men.

在REBOOT试验中，对于按照现代标准管理的心肌梗死(MI)患者，β受体阻滞剂治疗在女性中与有害证据相关，特别是那些左心室射血分数(LVEF)保持良好且接受更高剂量治疗的女性，而在男性中未观察到这种效应。