Comparative clinical outcomes of carvedilol versus bisoprolol in STEMI survivors after primary PCI: a propensity-score matched analysis

Background The clinical superiority between third-generation carvedilol and second-generation bisoprolol remains unclear in ST-segment elevation myocardial infarction (STEMI) survivors undergoing contemporary primary percutaneous coronary intervention (PCI). This study aimed to compare the long-term clinical outcomes of these two agents in a strictly defined STEMI cohort. Methods Using the nationwide Korea Acute Myocardial Infarction Registry, we identified 7,774 STEMI survivors who underwent successful primary PCI with second-generation drug-eluting stents. Patients were stratified based on prescription of either carvedilol (n=4,725) or bisoprolol (n=3,049) at discharge. To minimize selection bias, 1:1 propensity-score matching (PSM) was performed. The primary endpoint was 3-year all-cause mortality, and secondary endpoints included major adverse cardiac events (MACE). Results PSM yielded a well-balanced cohort of 5,186 patients, with 2,593 in each group. At 3 years, there was no significant difference in all-cause mortality between the carvedilol and bisoprolol groups (4.3% vs. 4.2%; HR 1.019; 95% CI 0.778-1.333; P=0.945). The incidence of MACE was also comparable (11.0% vs. 11.5%; HR 0.958; 95% CI 0.806-1.138; P=0.660). These neutral findings were consistent across major clinical subgroups, including patients with reduced left ventricular ejection fraction. Conclusion In STEMI survivors treated with contemporary primary PCI, carvedilol and bisoprolol demonstrated comparable 3-year clinical outcomes. This prognostic parity allows clinicians to individualize beta-blocker selection without compromising long-term survival or ischemic protection.