Chonnam Med J.  2018 May;54(2):121-128. 10.4068/cmj.2018.54.2.121.

Effects of Bisoprolol Are Comparable with Carvedilol in Secondary Prevention of Acute Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention

• Jun SJ
• Kim KH
• Jeong MH
• Kim MC
• Sim DS
• Hong YJ
• Kim JH
• Cho MC
• Chae JK
• Park HS
• Park JS
• Ahn YK

• KMID: 2411895
• DOI: http://doi.org/10.4068/cmj.2018.54.2.121

Abstract

Although the benefits of carvedilol have been demonstrated in the era of percutaneous coronary intervention (PCI), very few studies have evaluated the efficacy of bisoprolol in the secondary prevention of acute myocardial infarction (MI) in patients treated with PCI. We hypothesized that the effect of bisoprolol would not be different from carvedilol in post-MI patients. A total of 13,813 patients who underwent PCI were treated either with carvedilol or bisoprolol at the time of discharge. They were enrolled from the Korean Acute MI Registry (KAMIR). After 1:2 propensity score matching, 1,806 patients were enrolled in the bisoprolol group and 3,612 patients in the carvedilol group. The primary end point was the composite of major adverse cardiac events (MACEs), which was defined as cardiac death, nonfatal MI, target vessel revascularization, and coronary artery bypass surgery. The secondary end point was defined as all-cause mortality, cardiac death, nonfatal MI, any revascularization, or target vessel revascularization. After adjustment for differences in baseline characteristics by propensity score matching, the MACE-free survival rate was not different between the groups (HR=0.815, 95% CI:0.614-1.081, p=0.156). In the subgroup analysis, the cumulative incidence of MACEs was lower in the bisoprolol group in patients having a Killip class of III or IV than in the carvedilol group (HR=0.512, 95% CI: 0.263-0.998, p=0.049). The incidence of secondary end points was similar between the two beta-blocker groups. In conclusion, the benefits of bisoprolol were comparable with those of carvedilol in the secondary prevention of acute MI.

Keyword

Bisoprolol; Carvedilol; Myocardial Infarction; Percutaneous Coronary Intervention; Secondary Prevention

MeSH Terms

Bisoprolol*
Coronary Artery Bypass
Death
Humans
Incidence
Mortality
Myocardial Infarction*
Percutaneous Coronary Intervention*
Propensity Score
Secondary Prevention*
Survival Rate
Bisoprolol

Figure

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  FIG. 1 Comparison of the major adverse cardiac event (MACE)-free survival rate between the carvedilol and bisoprolol groups in post-myocardial infarction patients before (A) and after (B) propensity score matching. HR: hazard ratio.

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  FIG. 2 Comparison of the cumulative survival rate between the carvedilol and bisoprolol groups in post-myocardial infarction patients before (A) and after (B) propensity score matching. HR: hazard ratio.

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  FIG. 3 Comparison of secondary end points between the carvedilol and bisoprolol groups in post-myocardial infarction patients after propensity score matching: (A) cardiac death, (B) nonfatal myocardial infarction (MI), (C) repetition of revascularization, and (D) target vessel revascularization (TVR).

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  FIG. 4 Subgroup analysis for the cumulative incidence of major adverse cardiac events. STEMI: ST-segment elevation myocardial infarction, NSTEMI: non-ST-segment elevation myocardial infarction, LVEF: left ventricular ejection fraction.

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  FIG. 5 Subgroup analysis for the cumulative incidence of all-cause death. STEMI: ST-segment elevation myocardial infarction, NSTEMI: non ST-segment elevation myocardial infarction, LVEF: left ventricular ejection fraction.

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