Nebivolol prescription at discharge in STEMI patients with reduced LVEF was associated with similar 3-year all-cause death (HR 0.762; P=0.257) but lower MACE (HR 0.586; P=0.002) versus bisoprolol.
Cohort (n=1,317)
Yes
Does nebivolol reduce all-cause death or MACE in STEMI patients with reduced LVEF treated with DES compared to bisoprolol?
In STEMI patients with reduced LVEF undergoing PCI with DES, nebivolol at discharge was associated with a lower risk of MACE compared to bisoprolol, though all-cause mortality was similar.
Hazard Ratio: 0.762 (95% CI 0.486–1.193)
Absolute Event Rate: 5.5% vs 7.1%
p-value: p=0.257
Objective: This study aimed to compare the long-term clinical outcomes of nebivolol and bisoprolol in STEMI patients with reduced left ventricular ejection fraction (LVEF <40%) who underwent successful percutaneous coronary intervention (PCI) with drug-eluting stents (DES).Design and method: Data from the Korea Acute Myocardial Infarction Registry (KAMIR), including the KAMIR-National Institutes of Health (NIH) and KAMIR-V cohorts (2011–2020), were analyzed retrospectively. STEMI patients who survived hospitalization, underwent successful PCI with second-generation DES, and were discharged on either nebivolol or bisoprolol were included. The primary endpoint was all-cause death, and the secondary endpoint was major adverse cardiac events (MACE), which included a composite of all-cause death, myocardial infarction (MI), and revascularization. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. Results: A total of 1,317 STEMI patients with reduced LVEF (654 on nebivolol and 663 on bisoprolol) were included in the analysis. After IPTW adjustment, baseline characteristics were well balanced between the two groups. At 1 year, the incidence of total death was similar between the two groups (3.2% vs. 4.4%, HR: 0.724; 95% CI: 0.408–1.283, P=0.313), whereas the incidence of MACE was significantly lower in the nebivolol group (5.2% vs. 10.0%, HR: 0.495; 95% CI: 0.322–0.760, P=0.001). During the 3-year follow-up period, the total death rate remained similar between the two groups (5.5% vs. 7.1%, HR: 0.762; 95% CI: 0.486–1.193, P=0.257). However, the nebivolol group continued to show a significantly lower rate of MACE (9.9% vs. 15.8%, HR: 0.586; 95% CI: 0.421–0.815, P=0.002). These findings were consistent across subgroups, including age, sex, and the presence of diabetes mellitus. Conclusions: In STEMI patients with reduced LVEF treated with DES, nebivolol prescription at discharge was associated with a significantly lower incidence of MACE compared to bisoprolol, with similar rates of total death between the two groups after IPTW adjustment. These findings suggest that nebivolol may offer additional benefits in reducing MACE in this high-risk population. However, further randomized controlled trials are needed to confirm these results and assess the long-term benefits of nebivolol in comparison to bisoprolol.
Kim et al. (Fri,) conducted a cohort in STEMI with reduced LVEF (n=1,317). Nebivolol vs. Bisoprolol was evaluated on all-cause death (HR 0.762, 95% CI 0.486-1.193, p=0.257). Nebivolol prescription at discharge in STEMI patients with reduced LVEF was associated with similar 3-year all-cause death (HR 0.762; P=0.257) but lower MACE (HR 0.586; P=0.002) versus bisoprolol.