Key result
Preprocedural beta-blocker administration was not associated with 2-year cardiovascular or non-cardiovascular mortality overall, but lowered in-hospital congestive heart failure (p=0.046).
Why the study?
Data are scarce regarding optimal medical therapy, including beta-blocker use, for patients undergoing TAVR.
Does preprocedural beta-blocker administration reduce 2-year mortality and in-hospital outcomes in patients undergoing TAVR?
Cohort (n=2,563)
Yes
Does preprocedural beta-blocker administration reduce 2-year mortality and in-hospital outcomes in patients undergoing TAVR?
Preprocedural beta-blocker use in TAVR patients does not improve overall 2-year mortality but may offer cardiovascular mortality benefits in specific high-risk subgroups (prior CABG, PAD, elevated BNP, or reduced LVEF).
Beta blocker use post-TAVR was associated with lower CV mortality; leaves open whether RCTs would confirm benefit or alter practice.
OBJECTIVE: There is paucity of data on optimal medical treatment, including use of beta blockers for patients undergoing transcatheter aortic valve replacement (TAVR). The study aimed to investigate the association of beta blockers and clinical outcomes following TAVR. METHODS: We examined data of 2563 patients who underwent TAVR between October 2013 and May 2017 obtained from a prospective multicentre cohort registry, the optimised catheter valvular intervention-TAVI registry. We compared the 2-year cardiovascular and non-cardiovascular mortality and in-hospital outcomes between patients with and without preprocedural beta-blocker administration by propensity score matching (PSM). RESULTS: Preprocedural beta blockers were prescribed in 867 patients (33.8%). After PSM, the incidence of in-hospital congestive heart failure was significantly lower in patients with preprocedural beta blocker (p=0.046). No differences were found in 2-year cardiovascular and non-cardiovascular mortality. In the subgroup analyses, beta-blocker administration was associated with a lower cardiovascular mortality within 2 years in patients with a history of coronary artery bypass grafting (CABG; log-rank p=0.017), presence of peripheral artery disease (PAD; log-rank p=0.003) and brain natriuretic peptide (BNP) ≥400 pg/mL (log-rank p=0.003). When stratified by postprocedural left ventricular ejection fraction (post-LVEF), beta-blocker administration was associated with a lower cardiovascular mortality among patients with post-LVEF <50% (log-rank p=0.024). CONCLUSIONS: Preprocedural beta-blocker administration was not associated with 2-year cardiovascular and non-cardiovascular mortality in overall, but was associated with a lower 2-year cardiovascular mortality in patients with a history of CABG, presence of PAD, BNP ≥400 pg/mL and post-LVEF <50%. The findings must be validated using randomised trials.
No takes yet. Share an insight, caveat, or question.
Saito et al. (2020) conducted a cohort in transcatheter aortic valve replacement (TAVR) (n=2,563). Preprocedural beta blockers vs. No preprocedural beta blockers was evaluated on 2-year cardiovascular and non-cardiovascular mortality. Preprocedural beta-blocker administration was not associated with 2-year cardiovascular or non-cardiovascular mortality overall, but lowered in-hospital congestive heart failure (p=0.046).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: