β-blockers, calcium antagonists, and mortality in stable coronary artery disease: an international cohort study

Area of Science:

• Cardiology
• Clinical Outcomes Research

Background:

• The clinical impact of first-line antianginal agents, specifically beta-blockers and calcium antagonists, on stable coronary artery disease (CAD) outcomes is not fully understood.
• Uncertainty exists regarding the long-term benefits of these medications in managing stable CAD.

Purpose of the Study:

• To investigate the association between beta-blocker and calcium antagonist use and clinical outcomes in a large cohort of stable coronary artery disease (CAD) patients.
• To determine if baseline and time-varying use of these agents influences mortality and major cardiovascular events.

Main Methods:

• Analysis of 22,006 stable CAD patients from the CLARIFY registry (2009-2010), followed annually for 5 years.
• Multivariable adjustment was used to assess the association between beta-blocker/calcium antagonist use and outcomes, including all-cause death, cardiovascular death, and cardiovascular death/non-fatal myocardial infarction (MI).
• Sensitivity analyses explored the impact of beta-blocker use over time and prescribed dosage.

Main Results:

• Beta-blocker use at baseline was not associated with reduced all-cause death, cardiovascular death, or the composite of cardiovascular death/non-fatal MI in the overall stable CAD cohort.
• In patients with prior MI, those enrolled within one year of MI and using beta-blockers showed significantly lower all-cause death, cardiovascular death, and cardiovascular death/non-fatal MI.
• Calcium antagonist use was not linked to any significant difference in mortality outcomes, regardless of MI history.

Conclusions:

• In contemporary stable CAD patients, beta-blocker therapy is associated with improved 5-year mortality solely in individuals within the first year post-myocardial infarction (MI).
• Calcium antagonists did not demonstrate a mortality benefit in stable CAD patients, irrespective of their history of MI.
• These findings highlight a specific benefit of beta-blockers in the early post-MI period for stable CAD patients.