Does long-term beta-blocker therapy reduce major adverse cardiovascular events in patients with stable coronary artery disease without prior myocardial infarction or heart failure who underwent percutaneous coronary intervention?
In patients with stable CAD without prior MI or HF undergoing PCI, long-term beta-blocker therapy was not associated with improved clinical outcomes and showed a slightly higher risk of MACE.
Background It is unclear whether beta-blocker treatment is advantageous in patients with stable coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). We evaluated the clinical impact of long-term beta-blocker maintenance in patients with stable CAD after PCI with drug-eluting stent (DES). Methods From a nationwide cohort database, we identified the stable CAD patients without current or prior history of myocardial infarction or heart failure who underwent DES implantation. An intention-to-treat principle was used to analyze the impact of beta-blocker treatment on long-term outcomes of major adverse cardiovascular events (MACE) composed of cardiovascular death, myocardial infarction, and hospitalization with heart failure. Results After stabilized inverse probability of treatment weighting, a total of 78,380 patients with stable CAD was enrolled; 45,746 patients with and 32,634 without beta-blocker treatment. At 5 years after PCI with a 6-month quarantine period, the adjusted incidence of MACE was significantly higher in patients treated with beta-blockers 10.0 vs. 9.1%; hazard ratio (HR) 1.11, 95% CI 1.06–1.16, p 0.001 in an intention-to-treat analysis. There was no significant difference in all-cause death between patients treated with and without beta-blockers (8.1 vs. 8.2%; HR 0.99, 95% CI 0.94–1.04, p = 0.62). Statistical analysis with a time-varying Cox regression and rank-preserving structure failure time model revealed similar results to the intention-to-treat analysis. Conclusions Among patients with stable CAD undergoing DES implantation, long-term maintenance with beta-blocker treatment might not be associated with clinical outcome improvement. Trial Registration ClinicalTrial.gov (NCT04715594).
Lee et al. (Tue,) studied this question.