Consistent use of β-blockers after coronary artery bypass grafting was associated with a significantly lower risk of all-cause mortality compared to inconsistent use (HR 1.96) or never use (HR 1.42).
Cohort (n=5,926)
No
Does consistent long-term β-blocker therapy reduce all-cause death and MACCEs in patients undergoing isolated CABG?
Consistent long-term use of β-blockers after CABG is associated with a significantly lower risk of all-cause mortality and adverse cardiovascular events, regardless of prior MI history.
Effect estimate: HR 1.96 (95% CI 1.50-2.57)
Absolute Event Rate: 3.9% vs 6.6%
p-value: p=<0.001
BACKGROUND: Conflicting results from recent observational studies have raised questions concerning the benefit of β-blockers for patients undergoing coronary artery bypass grafting (CABG). Furthermore, the efficacy of long-term β-blocker therapy in CABG patients after hospital discharge is uncertain. METHODS AND RESULTS: The study included 5926 consecutive patients who underwent CABG and were discharged alive. The prevalence and consistency of β-blocker use were determined in patients with and without a history of myocardial infarction (MI). β-Blockers were always used in 1280 patients (50.9%) with and 1642 patients (48.1%) without previous MI after CABG. Compared with always users (n=2922, 49.3%), the risk of all-cause death was significantly higher among inconsistent β-blocker users (hazard ratio HR, 1.96; 95% confidence interval CI, 1.50-2.57), and never using β-blockers was associated with increased risk of both all-cause death (HR, 1.42; 95% CI, 1.01-2.00) and the composite of adverse cardiovascular events (HR, 1.29; 95% CI, 1.10-1.50). In the cohort without MI, the HR for all-cause death was 1.70 (95% CI, 1.17-2.48) in inconsistent users and 1.23 (95% CI, 0.76-1.99) in never users. In the MI cohort, mortality was higher for inconsistent users (HR, 2.14; 95% CI, 1.43-3.20) and for never users (HR, 1.59; 95% CI, 1.07-2.63). Consistent results were obtained in equivalent sensitivity analyses. CONCLUSIONS: In patients with or without previous MI undergoing CABG, the consistent use of β-blockers was associated with a lower risk of long-term mortality and adverse cardiovascular events. Strategies should be developed to understand and improve discharge prescription of β-blockers and long-term patient adherence.
Zhang et al. (2015) conducted a cohort in Coronary Artery Bypass Grafting (CABG) (n=5,926). Consistent β-blocker therapy vs. Inconsistent use of β-blockers was evaluated on All-cause death (HR 1.96, 95% CI 1.50-2.57, p=<0.001). Consistent use of β-blockers after coronary artery bypass grafting was associated with a significantly lower risk of all-cause mortality compared to inconsistent use (HR 1.96) or never use (HR 1.42).