Korean Circ J.  2022 Jul;52(7):544-555. 10.4070/kcj.2021.0395.

The Clinical Impact of β-Blocker Therapy on Patients With Chronic Coronary Artery Disease After Percutaneous Coronary Intervention

Affiliations
  • 1Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 2Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
  • 3Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
  • 4Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
  • 5Department of Internal Medicine and Cardiovascular Center, Presbyterian Medical Center, Jeonju, Korea
  • 6Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
  • 7Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
  • 8Department of Internal Medicine, Inha University Hospital, Incheon, Korea
  • 9Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
  • 10Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 11Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
  • 12Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
  • 13Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea

Abstract

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 DrugEluting 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.

Keyword

Adrenergic beta-antagonists; Angina; stable; Percutaneous coronary intervention

Figure

  • Figure 1 Study flow.A total of 17,286 patients with CAD who had undergone PCI were screened for inclusion from the Grand-DES multi-center registry. We excluded patients whose prescription records of β-blockers were not available and those with non-continuous use of β-blockers during the follow-up period. Finally, a total of 3,075 patients with chronic CAD were included. After propensity score matching, a total of 1,170 pairs of patients were finally derived.CAD = coronary artery disease; DES = drug-eluting stent; PCI = percutaneous coronary intervention; PS = propensity score.

  • Figure 2 Clinical outcomes according to β-blocker therapy in matched population.Among the matched population, the β-blocker group was not associated with better clinical outcomes in primary outcome, all-cause death, cardiac death, and MI compared with the no β-blocker group.CI = confidence interval; HR = hazard ratio; MI = myocardial infarction.

  • Figure 3 Subgroup analysis for primary outcome and all-cause death associated with β-blocker therapy.There was no significant difference in primary outcome associated with β-blocker therapy across the various subgroups. β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/or revascularization.BES = Biolimus A9 eluting coronary stent; CHF = congestive heart failure; CI = confidence interval; DAPT = dual antiplatelet therapy; DES = drug-eluting stent; EES = Everolimus eluting coronary stent; HR = hazard ratio; LVEF = left ventricular ejection fraction; MI = myocardial infarction; ZES = Zotarolimus eluting coronary stent.

  • Figure 4 Clinical outcomes according to different doses of β-blockers.After dose stratification, there was a dose-dependent tendency of lower risk of mortality with higher β-blockers doses, although the result was not statistically significant.CI = confidence interval; HR = hazard ratio; MI = myocardial infarction.

  • Figure 5 Clinical outcomes according to different types of β-blockers.Compared with patients who received conventional β-blockers, those with vasodilating β-blockers were not associated with better clinical outcomes.CI = confidence interval; HR = hazard ratio; MI = myocardial infarction.


Cited by  1 articles

Role of β-Blockers in Chronic Coronary Artery Disease Management in the Percutaneous Coronary Intervention Era: Good Symptom Control or Something More?
Ji Woong Roh, Yongcheol Kim
Korean Circ J. 2022;52(7):556-557.    doi: 10.4070/kcj.2022.0105.


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