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β-blockers, calcium antagonists, and mortality in stable coronary artery disease: an international cohort study
Emmanuel Sorbets1,2, Philippe Gabriel Steg2,3, Robin Young4
1Cardiology Department, AP-HP, Hôpital Avicenne, 125 rue de Stalingrad, 93000 Bobigny, France and Paris 13 University, Sorbonne Paris Cité, 74 rue Marcel Cachin, Bobigny, France.
Insights
Beta-blocker use in stable coronary artery disease (CAD) patients did not improve mortality, except for those within a year of myocardial infarction (MI). Calcium antagonists showed no mortality benefit in CAD patients, irrespective of MI history.
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.
Aims:
The effect of first-line antianginal agents, β-blockers, and calcium antagonists on clinical outcomes in stable coronary artery disease (CAD) remains uncertain.
Methods And Results:
We analysed the use of β-blockers or calcium antagonists (baseline and annually) and outcomes in 22 006 stable CAD patients (enrolled 2009-2010) followed annually to 5 years, in the CLARIFY registry (45 countries). Primary outcome was all-cause death. Secondary outcomes were cardiovascular death and the composite of cardiovascular death/non-fatal myocardial infarction (MI). After multivariable adjustment, baseline β-blocker use was not associated with lower all-cause death [1345 (7.8%) in users vs. 407 (8.4%) in non-users; hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.84-1.06; P = 0.30]; cardiovascular death [861 (5.0%) vs. 262 (5.4%); HR 0.91, 95% CI 0.79-1.05; P = 0.20]; or cardiovascular death/non-fatal MI [1272 (7.4%) vs. 340 (7.0%); HR 1.03, 95% CI 0.91-1.16; P = 0.66]. Sensitivity analyses according to β-blocker use over time and to prescribed dose produced similar results. Among prior MI patients, for those enrolled in the year following MI, baseline β-blocker use was associated with lower all-cause death [205 (7.0%) vs. 59 (10.3%); HR 0.68, 95% CI 0.50-0.91; P = 0.01]; cardiovascular death [132 (4.5%) vs. 49 (8.5%); HR 0.52, 95% CI 0.37-0.73; P = 0.0001]; and cardiovascular death/non-fatal MI [212 (7.2%) vs. 59 (10.3%); HR 0.69, 95% CI 0.52-0.93; P = 0.01]. Calcium antagonists were not associated with any difference in mortality.
Conclusion:
In this contemporary cohort of stable CAD, β-blocker use was associated with lower 5-year mortality only in patients enrolled in the year following MI. Use of calcium antagonists was not associated with superior mortality, regardless of history of MI.
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