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Role of beta blockers following percutaneous coronary intervention for acute coronary syndrome
Kah Yong Peck1,2, Nick Andrianopoulos3, Diem Dinh3
1Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia.
Insights
Beta blocker (BB) use after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) is associated with reduced mortality, particularly in patients with reduced left ventricular ejection fraction (LVEF). This finding supports BB use in specific ACS patient subgroups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Evidence for routine beta blocker (BB) use post-percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) is limited.
- Understanding BB's impact on mortality in ACS patients undergoing PCI is crucial for clinical practice.
Purpose of the Study:
- To evaluate the association between post-PCI BB use and all-cause mortality in ACS patients.
- To analyze the impact of BB on mortality across different left ventricular ejection fraction (LVEF) subgroups.
Main Methods:
- Analysis of a large PCI registry including ACS patients from January 2005 to June 2017.
- Comparison of mortality rates between patients on BB versus those not on BB at 30 days post-PCI.
- Multivariable Cox proportional hazards models used to assess mortality risk.
Main Results:
- 83.3% of 17,562 ACS patients received BB post-PCI.
- BB use was linked to significantly lower all-cause mortality (13.1% vs. 19.5%).
- Reduced mortality with BBs observed in LVEF <35% and LVEF 35%-50% subgroups, but not in LVEF >50%.
Conclusions:
- High BB utilization post-PCI in ACS patients is associated with improved survival.
- The mortality benefit of BBs is most pronounced in patients with reduced left ventricular ejection fraction.
- BBs may not offer a survival advantage in ACS patients with preserved ejection fraction.
Aims:
There is a paucity of evidence supporting routine beta blocker (BB) use in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). The aim of this study was to evaluate BB use post PCI and its association with mortality. Furthermore, the study aimed to evaluate the association between BB and mortality in the subgroups of patients with left ventricular ejection fraction (LVEF) <35%, LVEF 35%-50% and LVEF >50%.
Methods:
Using a large PCI registry, data from patients with ACS between January 2005 and June 2017 who were alive at 30 days were analysed. Those patients taking BB at 30 days were compared with those who were not taking BB. The primary outcome was all-cause mortality. The mean follow-up was 5.3±3.5 years.
Results:
Of the 17 562 patients, 83.3% were on BB. Mortality was lower in the BB group (13.1% vs 19.5%, p=0.0001). Multivariable Cox proportional hazards model showed that BB use was associated with lower overall mortality (adjusted HR 0.87, 95% CI 0.78 to 0.97, p=0.014). In the subgroup analysis, BB use was associated with reduced mortality in LVEF <35% (adjusted HR 0.63, 95% CI 0.44 to 0.91, p=0.013), LVEF 35%-50% (adjusted HR 0.80, 95% CI 0.68 to 0.95, p=0.01), but not LVEF >50% (adjusted HR 1.03, 95% CI 0.87 to 1.21, p=0.74).
Conclusion:
BB use remains high and is associated with reduced mortality. This reduction in mortality is primarily seen in those with reduced ejection fraction, but not in those with preserved ejection fraction.
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