The Clinical Impact of β-Blocker Therapy on Patients With Chronic Coronary Artery Disease After Percutaneous Coronary
Jiesuck Park1, Jung-Kyu Han2, Jeehoon Kang1
1Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Beta-blocker therapy showed no overall benefit for patients with chronic coronary artery disease (CAD) after percutaneous coronary intervention (PCI). However, a potential mortality benefit was observed in patients with prior myocardial infarction (MI) or revascularization.
Area of Science:
- Cardiology
- Pharmacology
Background:
- The benefits of beta-blockers in chronic coronary artery disease (CAD) require further assessment.
- Percutaneous coronary intervention (PCI) is a common treatment for CAD.
Purpose of the Study:
- To evaluate the prognostic impact of beta-blockers in patients with chronic CAD after PCI.
- To analyze the benefits of different beta-blocker doses and types.
Main Methods:
- A total of 3,075 patients with chronic CAD were analyzed from the Grand Drug-Eluting Stent registry.
- Propensity score matching created 1,170 pairs of patients (beta-blockers vs. no beta-blockers).
- The primary outcome was a composite of all-cause death and myocardial infarction (MI).
Main Results:
- Beta-blockers did not significantly reduce the primary outcome, all-cause death, or MI in the overall cohort.
- A subgroup analysis revealed a reduced risk of all-cause death in patients with previous MI and/or revascularization (HR, 0.38; 95% CI, 0.14-0.99).
- No significant associations were found between clinical outcomes and different doses or types of beta-blockers.
Conclusions:
- Beta-blocker therapy was not associated with improved clinical outcomes in patients with chronic CAD undergoing PCI.
- A potential mortality benefit of beta-blockers may exist for specific patient subgroups, including those with prior MI and/or revascularization.
Background And Objectives:
The outcome benefits of β-blockers in chronic coronary artery disease (CAD) have not been fully assessed. We evaluated the prognostic impact of β-blockers on patients with chronic CAD after percutaneous coronary intervention (PCI).
Methods:
A total of 3,075 patients with chronic CAD were included from the Grand Drug-Eluting Stent registry. We analyzed β-blocker prescriptions, including doses and types, in each patient at 3-month intervals from discharge. After propensity score matching, 1,170 pairs of patients (β-blockers vs. no β-blockers) were derived. Primary outcome was defined as a composite endpoint of all-cause death and myocardial infarction (MI). We further analyzed the outcome benefits of different doses (low-, medium-, and high-dose) and types (conventional or vasodilating) of β-blockers.
Results:
During a median (interquartile range) follow-up of 3.1 (3.0-3.1) years, 134 (5.7%) patients experienced primary outcome. Overall, β-blockers demonstrated no significant benefit in primary outcome (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.63-1.24), all-cause death (HR, 0.87; 95% CI, 0.60-1.25), and MI (HR, 1.25; 95% CI, 0.49-3.15). In subgroup analysis, β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/or revascularization (HR, 0.38; 95% CI, 0.14-0.99) (p for interaction=0.045). No significant associations were found for the clinical outcomes with different doses and types of β-blockers.
Conclusions:
Overall, β-blocker therapy was not associated with better clinical outcomes in patients with chronic CAD undergoing PCI. Limited mortality benefit of β-blockers may exist for patients with previous MI and/or revascularization.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03507205.
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