Beta-blocker use before percutaneous coronary intervention did not decrease myocardial injury, showing no difference in maximum CK rise (P=0.21) or CK-MB rise (P=0.99) after adjustment.
Observational (n=6,200)
Does beta-blocker use before PCI reduce postprocedural creatine kinase isoenzyme rise in patients undergoing PCI?
Observational data adjusted for baseline differences show that beta-blocker use prior to PCI does not attenuate postprocedural myocardial injury markers.
p-value: p=0.21 for CK, 0.99 for CK-MB
BACKGROUND: beta-blocker (BB) use reduces infarct size in spontaneously occurring nonreperfused infarcts but probably does not change infarct size in patients treated with reperfusion therapy. A recent observational study suggested that BB use concurrent with percutaneous coronary intervention (PCI) decreased the risk of creatine kinase (CK)-MB elevation. The cogency of such a conclusion is dependent on the ability to risk-adjust for the multiple differences in patients treated with and without BBs. METHODS AND RESULTS: Using propensity score and multivariate regression analyses, 6200 consecutive patients were analyzed to assess the relationship between BB use before PCI and per protocol-measured CK and CK-MB rise. There were several highly significant (P<0.001) differences between patients with and without BB treatment (eg, age, prior infarction, unstable angina). Maximum CK and CK-MB levels were higher in patients taking BBs (CK median, 95 U interquartile range: 61, 175; CK-MB, 3 U 2, 5) than in patients not taking BBs (CK, 91 U 60, 157; CK-MB, 3 U 2, 4) (P=0.011 and P=0.021 for CK and CK-MB, respectively). After adjustment for significant differences in baseline characteristics there was no difference in either maximum CK rise (P=0.21) or maximum CK-MB rise (P=0.99). CONCLUSIONS: The results of this large observation study do not support the contention that BB use before PCI decreases myocardial injury.
Ellis et al. (Tue,) conducted a observational in Percutaneous coronary intervention (n=6,200). Beta-blockers vs. No beta-blockers was evaluated on Maximum CK and CK-MB rise (p=0.21 for CK, 0.99 for CK-MB). Beta-blocker use before percutaneous coronary intervention did not decrease myocardial injury, showing no difference in maximum CK rise (P=0.21) or CK-MB rise (P=0.99) after adjustment.