Beta-Blockers and Outcome in Patients with Suspected Coronary Artery Disease Evaluated Noninvasively

Our intent was to assess the relationship between beta-blocker use and outcomes in patients with chronic coronary artery disease diagnosed using noninvasive testing but without myocardial infarction or heart failure.

Data from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) study, a prospective randomized trial comparing the effectiveness of 2 noninvasive tests in patients with a low-to-intermediate likelihood of coronary artery disease, were subjected to post hoc analysis. Patients with a history of myocardial infarction or heart failure and those with missing data on beta-blocker use at baseline were excluded. Associations between baseline beta-blocker use and the primary composite outcome (all-cause death / myocardial infarction / unstable angina hospitalization) and secondary composite outcomes (cardiovascular death / myocardial infarction / unstable angina hospitalization, and myocardial infarction / unstable angina hospitalization) over a median follow-up period of 793 days were analyzed.

In total, 8,250 patients were enrolled and stratified into negative (87.5%, n = 7,215) and positive (12.5%, n = 1,035) cohorts based on noninvasive test results, of which 23.9% and 28.6% received beta-blockers, respectively. In both cohorts, patients who received beta-blockers had a similar risk of the primary composite outcome compared to those who did not receive beta-blockers (negative cohort: adjusted hazard ratio = 1.106, P = .586; positive cohort: adjusted hazard ratio = 1.077, P = .759). Similar results were observed for the secondary composite outcomes.

This non-randomized study showed that beta-blocker use did not affect the clinical outcomes in patients with chronic coronary artery disease diagnosed using noninvasive testing, if they had no myocardial infarction or heart failure.