Key result
Nebivolol shows comparable 3-year mortality to bisoprolol after primary PCI for STEMI.
Why the study?
Despite advances in primary PCI, uncertainty remains regarding the routine use of beta-blockers and potential heterogeneity among individual agents like nebivolol and bisoprolol in the management of STEMI.
Does nebivolol improve all-cause death compared to bisoprolol in patients with STEMI undergoing primary PCI?
Cohort (n=5,076)
Yes
Does nebivolol improve all-cause death compared to bisoprolol in patients with STEMI undergoing primary PCI?
In patients with STEMI undergoing primary PCI with second-generation DES, nebivolol and bisoprolol demonstrate comparable 1-year and 3-year clinical outcomes including all-cause mortality and MACE.
Similar outcomes with nebivolol or bisoprolol in matched STEMI cohorts; should not change practice and leaves open randomized confirmation.
Background and Aims Despite advances in primary percutaneous coronary intervention (PCI), uncertainty remains regarding the routine use of beta-blockers and potential heterogeneity among individual agents in the management of ST-segment elevation myocardial infarction (STEMI). This study aimed to investigate the clinical outcomes associated with nebivolol versus bisoprolol in patients with STEMI undergoing primary PCI. Methods From Korea Acute Myocardial Infarction Registry between 2011 to 2020, 5,076 patients with STEMI who underwent successful primary PCI with second-generation DES were eligible for the final analysis. The primary endpoint was all-cause death. The secondary endpoints were stroke, stent thrombosis, cardiac death, and hospitalization for heart failure (HF), and major adverse cardiac events (MACE), a composite of all-cause death, recurrent myocardial infarction (MI), and any repeat revascularization. Results Among the study population, 2,027 patients received nebivolol and 3,049 received bisoprolol. After 1:1 propensity score matching, 1,605 patients were included in each group. During follow-up, clinical outcomes were comparable between the nebivolol and bisoprolol groups in the propensity score-matched cohort. At 1 year, the incidence of MACE did not differ significantly between groups [HR 0.877; 95% CI 0.639–1.204; P = 0.468]. Similarly, no significant differences were observed in all-cause death (1.7% vs. 2.1%; P = 0.605) or MI (0.7% vs. 0.8%; P = 0.838). At 3 years, rates of all-cause death (3.7% in the nebivolol group and 4.3% in the bisoprolol group, HR 0.864; 95% CI 0.607–1.230; P = 0.472) and MACE (10.1% of nebivolol users and 11.0% of bisoprolol users, HR 0.905; 95% CI 0.723–1.134; P = 0.421) remained comparable between the two groups. Conclusions Among patients with STEMI treated with primary PCI, nebivolol and bisoprolol were associated with comparable clinical outcomes.
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Park et al. (2026) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=5,076). Nebivolol vs. Bisoprolol was evaluated on All-cause death (HR 0.864, 95% CI 0.607-1.230, p=0.472). Nebivolol and bisoprolol had comparable 3-year all-cause mortality in STEMI patients after primary PCI (3.7% vs. 4.3%; HR 0.864, 95% CI 0.607–1.230; P=0.472).
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