Early beta-blocker initiation after PCI for stable CAD with preserved LVEF was associated with increased all-cause mortality (HR 1.11; 95% CI 1.09-1.18) compared with no initiation.
Cohort (n=23,362)
Yes
Does early beta-blocker initiation improve outcomes in patients with stable CAD and preserved LVEF following PCI?
Early beta-blocker initiation after PCI in stable CAD patients with preserved LVEF is associated with increased mortality and higher risk of hypotension, without reducing cardiovascular events.
Effect estimate: HR 1.11 (95% CI 1.09-1.18)
BACKGROUND: Limited data exist on the long-term impact of beta-blocker therapy after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF). OBJECTIVES: The aim of the study was to evaluate the effects of early beta-blocker initiation vs no initiation following PCI in patients with stable CAD and preserved LVEF. METHODS: This retrospective cohort study employed target trial emulation and incident user design, utilizing the TriNetx database (2009-2024). Early beta-blocker initiation (within days 1 and 7) was compared with no initiation using 1:1 greedy propensity score matching. The outcomes included all-cause mortality, hospitalization for myocardial infarction, heart failure, atrial fibrillation/flutter, stroke, and safety endpoints. Hospitalization for bone fracture and acute appendicitis served as falsification endpoints. In the intention-to-treat analysis, outcomes were analyzed over 5 years using Cox-proportional hazards. RESULTS: Out of 11,681 matched patients per group, beta-blocker therapy was associated with increased all-cause mortality (HR: 1.11 95% CI: 1.09-1.18). No significant differences were found in hospitalization for myocardial infarction (HR: 1.03 95% CI: 0.97-1.09), stroke (HR: 0.98 95% CI: 0.91-1.05), heart failure (HR: 0.99 95% CI: 0.95-1.03), and atrial fibrillation/flutter (HR: 0.97 95% CI: 0.93-1.01). Hospitalization for hypotension was higher with beta-blockers (HR: 1.10 95% CI: 1.06-1.14). Hospitalization for bone fracture (HR: 1.02 95% CI: 0.85-1.22) and acute appendicitis (HR: 1.17 95% CI: 0.95-1.45) showed no significant associations. Several sensitivity analyses showed consistent results. CONCLUSIONS: Early beta-blocker initiation after PCI for stable CAD with preserved LVEF was associated with higher mortality, with no impact on cardiovascular events.
Khan et al. (Sat,) conducted a cohort in Stable coronary artery disease with preserved left ventricular ejection fraction after PCI (n=23,362). Early beta-blocker initiation vs. No initiation was evaluated on All-cause mortality (HR 1.11, 95% CI 1.09-1.18). Early beta-blocker initiation after PCI for stable CAD with preserved LVEF was associated with increased all-cause mortality (HR 1.11; 95% CI 1.09-1.18) compared with no initiation.