April 7, 2026Open Access

Beta-blocker therapy and all-cause mortality after a coronary event: A matched nested case-control study using the Victorian Cardiac Outcomes Registry linked data

Q: What does this research mean for the field?

Beta-blocker therapy following a coronary event and PCI does not provide a survival benefit and is associated with increased all-cause mortality in patients with preserved or mildly reduced left ventricular ejection fraction. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Key Result

Beta-blocker therapy after PCI was associated with higher all-cause mortality in patients with preserved (OR 1.46) and mildly reduced LVEF (OR 1.48), with no benefit in those with lower LVEF.

Key Points

This research aims to evaluate the relationship between beta-blocker therapy and all-cause mortality after a coronary event, with a focus on left ventricular ejection fraction (LVEF) status.
Utilized a state-wide nested case-control design from the Victorian Cardiac Outcomes Registry linked to the Australian National Death Index.
Stratified patients into groups based on LVEF: preserved, mildly reduced, moderately reduced, and severely reduced.
Employed propensity score matching and logistic regression with cluster-robust standard errors to analyze outcomes.
Conducted sensitivity analyses for missing LVEF data and evaluated cardiovascular mortality at 30 days after PCI.
Among 71,053 patients, 67.3% received beta-blockers.
Higher odds of all-cause mortality were found in patients with preserved LVEF (OR 1.46) and mildly reduced LVEF (OR 1.48) after matching.
No significant benefit of beta-blocker therapy was observed in patients with moderately or severely reduced LVEF.
Subgroup analyses confirmed increased mortality odds for preserved and mildly reduced LVEF across various clinical contexts.

Structured PICO

Does beta-blocker therapy improve all-cause mortality in adults discharged alive after PCI across different LVEF strata?

Population

71,053 adults discharged alive after percutaneous coronary intervention (PCI) following a coronary event, stratified by left ventricular ejection fraction (LVEF): preserved (≥50%), mildly reduced (45-49%), moderately reduced (35-44%), and severely reduced (<35%).

Intervention

Beta-blocker therapy prescription

Comparator

Propensity score-matched control group not receiving beta-blocker therapy

Outcome

All-cause mortalityhard clinical

Routine beta-blocker prescription after PCI is associated with increased mortality in patients with preserved or mildly reduced LVEF and offers no clear survival benefit in those with reduced LVEF, challenging current secondary prevention practices.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

• Beta-blockers were not associated with survival benefit after PCI. • Mortality risk increased in preserved and mildly reduced LVEF. • Effect of beta-blockers varied significantly across LVEF strata. • Findings challenge routine beta-blocker use in modern care post-PCI. • Advanced causal inference using propensity-matched nested case-control design. Beta-blocker therapy has traditionally been recommended following coronary events based on clinical trials involving patients with systolic dysfunction. Its survival benefit in patients with preserved left ventricular ejection fraction (LVEF), is being re-examined. This study assessed the association of beta-blocker therapy prescription and all-cause mortality following a coronary event and percutaneous coronary intervention (PCI), stratified by LVEF. A state-wide nested case-control study of data from the Victorian Cardiac Outcomes Registry linked to the Australian National Death Index (2014–2022) was conducted. Adults discharged alive after PCI were stratified by LVEF: preserved (≥50%), mildly reduced (45-49%), moderately reduced (35-44%), and severely reduced (<35%). Propensity score matching and logistic regression models with cluster-robust standard errors were used to assess associations. Sensitivity analyses evaluated missing LVEF data and cardiovascular mortality at 30-days. Among 71,053 patients, 67.3% received beta-blockers. After matching, beta-blocker therapy was associated with higher odds of all-cause mortality in patients with preserved (OR 1.46, 95% CI 1.29–1.65) and mildly reduced LVEF (OR 1.48, 95% CI 1.15–1.91), with no significant benefit in moderately or severely reduced LVEF. Subgroup analyses confirmed higher odds of mortality for these LVEF groups in several clinical contexts. Sensitivity analyses supported primary findings. Beta-blocker therapy was associated with increased all-cause mortality in patients with preserved and mildly reduced LVEF, with no clear benefit in those with lower LVEF. These real-world findings support recent trials and challenge the routine prescription of beta-blocker therapy post-MI, highlighting the need for individualised treatment.