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Beta blockers and long-term outcome after coronary artery bypass grafting: a nationwide observational study
Martin Lindgren1,2, Susanne J Nielsen2,3, Erik Björklund2,4
1Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
Insights
Long-term use of cardioselective beta blockers after coronary artery bypass grafting (CABG) reduces major adverse cardiovascular events (MACEs), primarily by lowering the risk of myocardial infarction (MI). This benefit was observed across various patient subgroups.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Beta blockers are crucial for managing cardiovascular disease.
- Their long-term use after coronary artery bypass grafting (CABG) requires further investigation.
Purpose of the Study:
- To assess the long-term utilization of beta blockers post-CABG.
- To evaluate the association between beta blocker use and patient outcomes.
Main Methods:
- Nationwide observational study of 35,184 patients undergoing first-time isolated CABG in Sweden (2006-2017).
- Multivariable Cox regression with time-updated prescription data.
- Primary outcome: major adverse cardiovascular events (MACEs) including mortality, stroke, and myocardial infarction (MI).
Main Results:
- 94.2% of patients received beta blockers at baseline; cardioselective agents were most common (92.2%).
- After 10 years, cardioselective beta blocker use decreased to 73.7%.
- Ongoing cardioselective beta blocker treatment showed a slight MACE reduction (HR 0.93), driven by decreased MI risk (HR 0.83), with no significant impact on mortality or stroke.
Conclusions:
- Cardioselective beta blockers post-CABG are linked to reduced long-term MACEs, primarily due to a lower risk of MI.
- This association was consistent across subgroups, including those with prior MI, heart failure, or reduced LVEF.
Aims:
Beta blockers are associated with improved outcomes for selected patients with cardiovascular disease. We assessed long-term utilization of beta blockers after coronary artery bypass grafting (CABG) and its association with outcome.
Methods And Results:
All 35 184 patients in Sweden who underwent first-time isolated CABG between 1 January 2006 and 31 December 2017 and were followed for at least 6 months were included in a nationwide observational study. Multivariable Cox regression models using time-updated data on dispensed prescriptions were used to assess associations between different types of beta blockers and outcomes. The primary outcome was major adverse cardiovascular events (MACEs), a composite of all-cause mortality, stroke, and myocardial infarction (MI). Subgroup analyses were performed in patients with and without previous MI, heart failure, and reduced left ventricular ejection fraction (LVEF). Median follow-up was 5.2 years (range 0-11). At baseline, 33 159 (94.2%) patients were dispensed beta blockers, 30 563 (92.2%) of which were cardioselective beta blockers. After 10 years, the dispensing of cardioselective beta blockers had declined to 73.7% of all patients. Ongoing treatment with cardioselective beta blockers was associated with a slight reduction in MACEs [hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.89-0.98, P = 0.0063]. The reduction was largely driven by a reduced risk of MI (HR 0.83, 95% CI 0.75-0.92, P = 0.0003), while there was no significant reduction in all-cause mortality (HR 0.99, 95% CI 0.93-1.05) and stroke (HR 0.96, 95% CI 0.87-1.05). The reduced risk for MI was consistent in all the investigated subgroups.
Conclusion:
Ongoing treatment with cardioselective beta blockers after CABG is associated with a reduction in MACEs, mainly because of reduced long-term risk for MI. The association between cardioselective beta blockers and MI was consistent in patients with and patients without previous MI, heart failure, atrial fibrillation, or reduced LVEF.
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