Key result
Beta-blockers linked to ~22% lower mortality in AMI post-PCI but lack survival benefit in angina.
Why the study?
There is limited evidence regarding the benefit of beta-blockers in the context of contemporary management following PCI.
Do beta-blockers reduce mortality risk in patients with coronary artery disease (AMI or angina) undergoing contemporary post-PCI management?
Cohort (n=87,980)
Yes
Do beta-blockers reduce mortality risk in patients with coronary artery disease (AMI or angina) undergoing contemporary post-PCI management?
Effect estimate: HR 0.78 (95% CI 0.69-0.87)
p-value: p=<0.001
In the contemporary post-PCI era, beta-blocker therapy provides a significant survival benefit for patients with acute myocardial infarction, but not for those with angina pectoris.
Supports selective post-PCI beta-blocker consideration in AMI; leaves open randomized confirmation for angina and contemporary CAD management.
Beta-adrenergic receptor blockers are used in patients with coronary artery disease (CAD) to reduce the harmful effects of excessive adrenergic activation on the heart. However, there is limited evidence regarding the benefit of beta-blockers in the context of contemporary management following percutaneous coronary intervention (PCI). We used the nationwide South Korea National Health Insurance database to identify 87,980 patients with a diagnosis of either acute myocardial infarction (AMI; n = 38,246) or angina pectoris (n = 49,734) who underwent PCI between 2013 and 2017, and survived to be discharged from hospital. Beta-blockers were used in a higher proportion of patients with AMI (80.6%) than those with angina (58.9%). Over a median follow-up of 2.2 years (interquartile range 1.2-3.3 years) with the propensity-score matching analysis, the mortality risk was significantly lower in patients treated with a beta-blocker in the AMI group (HR: 0.78; 95% CI 0.69-0.87; p < 0.001). However, the mortality risk was comparable regardless of beta-blocker use (HR: 1.07; 95% CI 0.98-1.16; p = 0.10) in the angina group. The survival benefit associated with beta-blocker therapy was most significant in the first year after the AMI event.
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Lee et al. (2020) conducted a cohort in Coronary artery disease (acute myocardial infarction or angina pectoris) undergoing percutaneous coronary intervention (n=87,980). Beta-blockers vs. No beta-blockers was evaluated on All-cause mortality (AMI cohort) (HR 0.78, 95% CI 0.69-0.87, p=<0.001). Beta-blockers reduced all-cause mortality (HR 0.78) in patients with acute myocardial infarction undergoing percutaneous coronary intervention, but showed no survival benefit in angina patients.