Long-term β-blocker exposure in elderly patients with coronary artery disease without prior myocardial infarction was significantly associated with an increased risk of major adverse cardiovascular events (HR 1.65).
Cohort (n=1,018)
No
Does long-term β-blocker use improve cardiovascular outcomes in elderly patients with CAD without MI or systolic HF after percutaneous coronary intervention?
In elderly patients with CAD without prior MI or reduced ejection fraction undergoing PCI, long-term β-blocker use was associated with an increased risk of adverse cardiovascular events, primarily driven by a higher rate of admission for heart failure.
Hazard Ratio: 1.65 (95% CI 1.05–2.64)
Absolute Event Rate: 15.4% vs 10%
p-value: p=0.029
AIMS: Little is known about the long-term outcomes of β-blockers use in patients with coronary artery disease (CAD) without myocardial infarction (MI) and reduced ejection fraction (rEF). However, more attention should be paid to the oral administration of β-blockers in elderly patients who are susceptible to heart failure (HF), sinus node dysfunction, or rate response insufficiency. We aimed to evaluate the long-term impact of β-blockers in elderly patients with CAD without MI or systolic HF who have undergone percutaneous coronary intervention. METHODS AND RESULTS: A total of 1018 consecutive elderly patients with CAD (mean age, 72 ± 7 years; 77% men) who underwent their first intervention between 2010 and 2018 were included in this study. According to the presence or absence of the use of β-blockers, 514 patients (50.5%) were allocated to the β-blocker group, and 504 (49.5%) to the non-β-blocker group. We evaluated the incidence of 4-point major adverse cardiovascular events (4P-MACE), including cardiovascular death, non-fatal MI, non-fatal stroke, admission for HF, target vessel revascularization (TVR), and all-cause death. We focused on the association between chronotropic incompetence of β-blockers and incidence of a new HF and analysed the results using an exercise electrocardiogram regularly performed in the outpatient department after percutaneous coronary intervention. During a median follow-up duration of 5.1 years, 83 patients (8.3%) developed 4P-MACE, including cardiovascular death in 17, non-fatal MI in 13, non-fatal stroke in 25, and admission for HF in 39 patients. Additionally, 124 patients (12.2%) had a TVR and 104 (10.2%) died of other causes. Kaplan-Meier analysis showed that the cumulative incidence rate of 4P-MACE in the β-blocker group was significantly higher than that in the non-β-blocker group (15.4% vs. 10.0%, log-rank test, P = 0.015). Above all, the cumulative incidence rate of admission for HF in the β-blocker group was significantly higher (8.8% vs. 3.2%, log-rank test, P < 0.001). The β-blocker group had significantly lower resting heart rate, stress heart rate, and stress-rest Δ heart rate on exercise electrocardiogram. Multivariate Cox hazard analysis revealed that EF, β-blocker use, stress-rest Δ heart rate, and CKD were strong independent predictors of admission for HF. CONCLUSIONS: Long-term β-blocker use was significantly associated with an increased risk of adverse cardiovascular events in elderly patients with CAD without MI or systolic HF. In particular, the chronotropic incompetence action of β-blockers could increase the risk of admission for HF in elderly patients with CAD without MI and systolic HF, and the present findings warrant further investigation.
Fukase et al. (Mon,) conducted a cohort in Coronary artery disease without myocardial infarction or reduced ejection fraction after percutaneous coronary intervention (n=1,018). β-blockers vs. No β-blockers was evaluated on 4-point major adverse cardiovascular events (4P-MACE: cardiovascular death, non-fatal MI, non-fatal stroke, admission for heart failure) (HR 1.65, 95% CI 1.05-2.64, p=0.029). Long-term β-blocker exposure in elderly patients with coronary artery disease without prior myocardial infarction was significantly associated with an increased risk of major adverse cardiovascular events (HR 1.65).