Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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The Clinical Impact of β-Blocker Therapy on Patients With Chronic Coronary Artery Disease After Percutaneous Coronary Intervention

  • Jiesuck Park (Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital) ;
  • Jung-Kyu Han (Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital) ;
  • Jeehoon Kang (Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital) ;
  • In-Ho Chae (Cardiovascular Center, Seoul National University Bundang Hospital) ;
  • Sung Yun Lee (Department of Internal Medicine, Inje University Ilsan Paik Hospital) ;
  • Young Jin Choi (Department of Internal Medicine, Sejong General Hospital) ;
  • Jay Young Rhew (Department of Internal Medicine and Cardiovascular Center, Presbyterian Medical Center) ;
  • Seung-Woon Rha (Cardiovascular Center, Korea University Guro Hospital) ;
  • Eun-Seok Shin (Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Seong-Ill Woo (Department of Internal Medicine, Inha University Hospital) ;
  • Han Cheol Lee (Department of Internal Medicine, Pusan National University Hospital) ;
  • Kook-Jin Chun (Department of Internal Medicine, Pusan National University Yangsan Hospital) ;
  • DooIl Kim (Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Jin-Ok Jeong (Department of Internal Medicine, Chungnam National University College of Medicine) ;
  • Jang-Whan Bae (Department of Internal Medicine, Chungbuk National University College of Medicine) ;
  • Han-Mo Yang (Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital) ;
  • Kyung Woo Park (Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital) ;
  • Hyun-Jae Kang (Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital) ;
  • Bon-Kwon Koo (Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital) ;
  • Hyo-Soo Kim (Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital)
  • Received : 2021.12.03
  • Accepted : 2022.03.10
  • Published : 2022.07.01
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Abstract

Background and Objectives: The outcome benefits of β-blockers in chronic coronary artery disease (CAD) have not been fully assessed. We evaluated the prognostic impact of β-blockers on patients with chronic CAD after percutaneous coronary intervention (PCI). Methods: A total of 3,075 patients with chronic CAD were included from the Grand Drug-Eluting Stent registry. We analyzed β-blocker prescriptions, including doses and types, in each patient at 3-month intervals from discharge. After propensity score matching, 1,170 pairs of patients (β-blockers vs. no β-blockers) were derived. Primary outcome was defined as a composite endpoint of all-cause death and myocardial infarction (MI). We further analyzed the outcome benefits of different doses (low-, medium-, and high-dose) and types (conventional or vasodilating) of β-blockers. Results: During a median (interquartile range) follow-up of 3.1 (3.0-3.1) years, 134 (5.7%) patients experienced primary outcome. Overall, β-blockers demonstrated no significant benefit in primary outcome (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.63-1.24), all-cause death (HR, 0.87; 95% CI, 0.60-1.25), and MI (HR, 1.25; 95% CI, 0.49-3.15). In subgroup analysis, β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/or revascularization (HR, 0.38; 95% CI, 0.14-0.99) (p for interaction=0.045). No significant associations were found for the clinical outcomes with different doses and types of β-blockers. Conclusions: Overall, β-blocker therapy was not associated with better clinical outcomes in patients with chronic CAD undergoing PCI. Limited mortality benefit of β-blockers may exist for patients with previous MI and/or revascularization.

Keywords

Acknowledgement

This study was funded by Chong Kun Dang Inc. (Seoul, Republic of Korea) (grant 0620173860).

References

  1. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001;357:1385-90.
  2. Puymirat E, Riant E, Aissaoui N, et al. β blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study. BMJ 2016;354:i4801.
  3. Dahl Aarvik M, Sandven I, Dondo TB, et al. Effect of oral β-blocker treatment on mortality in contemporary post-myocardial infarction patients: a systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother 2019;5:12-20.
  4. Hwang D, Lee JM, Kim HK, et al. Prognostic impact of β-blocker dose after acute myocardial infarction. Circ J 2019;83:410-7.
  5. Packer M, Coats AJ, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001;344:1651-8.
  6. Leizorovicz A, Lechat P, Cucherat M, Bugnard F. Bisoprolol for the treatment of chronic heart failure: a meta-analysis on individual data of two placebo-controlled studies--CIBIS and CIBIS II. Cardiac Insufficiency Bisoprolol Study. Am Heart J 2002;143:301-7.
  7. Andersson C, Shilane D, Go AS, et al. β-Blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease. J Am Coll Cardiol 2014;64:247-52.
  8. Bangalore S, Steg G, Deedwania P, et al. β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA 2012;308:1340-9.
  9. Motivala AA, Parikh V, Roe M, et al. Predictors, trends, and outcomes (among older patients ≥65 years of age) associated with beta-blocker use in patients with stable angina undergoing elective percutaneous coronary intervention: insights from the NCDR registry. JACC Cardiovasc Interv 2016;9:1639-48.
  10. Hjalmarson A, Elmfeldt D, Herlitz J, et al. Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomised trial. Lancet 1981;2:823-7.
  11. Johnston DL, Gebhardt VA, Donald A, Kostuk WJ. Comparative effects of propranolol and verapamil alone and in combination on left ventricular function and volumes in patients with chronic exertional angina: a double-blind, placebo-controlled, randomized, crossover study with radionuclide ventriculography. Circulation 1983;68:1280-9.
  12. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999;353:9-13.
  13. Viskin S, Kitzis I, Lev E, et al. Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. J Am Coll Cardiol 1995;25:1327-32.
  14. Ambrosio G, Flather MD, Bohm M, et al. β-blockade with nebivolol for prevention of acute ischaemic events in elderly patients with heart failure. Heart 2011;97:209-14.
  15. Narahara KA; Betaxolol Investigators Group. Double-blind comparison of once daily betaxolol versus propranolol four times daily in stable angina pectoris. Am J Cardiol 1990;65:577-82.
  16. Rodrigues EA, Lawrence JD, Dasgupta P, et al. Comparison of bevantolol and atenolol in chronic stable angina. Am J Cardiol 1988;61:1204-9.
  17. Sorbets E, Steg PG, Young R, et al. β-Blockers, calcium antagonists, and mortality in stable coronary artery disease: an international cohort study. Eur Heart J 2019;40:1399-407.
  18. Goldberger JJ, Bonow RO, Cuffe M, et al. Effect of beta-blocker dose on survival after acute myocardial infarction. J Am Coll Cardiol 2015;66:1431-41.
  19. Park J, Han JK, Kang J, et al. Optimal dose and type of β-blockers in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Cardiol 2020;137:12-9.
  20. Parsons LS. Reducing bias in a propensity score matched-pair sample using greedy matching techniques. In: Proceedings of the Twenty-Sixth Annual SAS Users Group International Conference; 2001 Apr 22-25; Long Beach, CA. [place unknown]: SAS User Groups; 2001.
  21. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 2009;28:3083-107.
  22. Bangalore S, Bhatt DL, Steg PG, et al. β-Blockers and cardiovascular events in patients with and without myocardial infarction: post hoc analysis from the CHARISMA trial. Circ Cardiovasc Qual Outcomes 2014;7:872-81.
  23. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41:407-77.
  24. Diaz A, Bourassa MG, Guertin MC, Tardif JC. Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease. Eur Heart J 2005;26:967-74.
  25. Bangalore S, Makani H, Radford M, et al. Clinical outcomes with β-blockers for myocardial infarction: a meta-analysis of randomized trials. Am J Med 2014;127:939-53.
  26. Fonseca VA. Effects of beta-blockers on glucose and lipid metabolism. Curr Med Res Opin 2010;26:615-29.
  27. Chung J, Han JK, Kim YJ, et al. Benefit of vasodilating β-blockers in patients with acute myocardial infarction after percutaneous coronary intervention: nationwide multicenter cohort study. J Am Heart Assoc 2017;6:e007063.
  28. McEniery CM, Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB. Central blood pressure: current evidence and clinical importance. Eur Heart J 2014;35:1719-25.
  29. Chung J, Han JK, Yang HM, et al. Long-term efficacy of vasodilating β-blocker in patients with acute myocardial infarction: nationwide multicenter prospective registry. Korean J Intern Med 2021;36:S62-71.