The Clinical Impact of β-Blocker Therapy on Patients With Chronic Coronary Artery Disease After Percutaneous Coronary Intervention

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.

Trial registration: ClinicalTrials.gov Identifier: NCT03507205.

Keywords: Adrenergic beta-antagonists; Angina, stable; Percutaneous coronary intervention.

Conflict of interest statement

The authors have no financial conflicts of interest.

Copyright © 2022. The Korean Society of Cardiology.

Figures

Figure 1. Study flow.

A total of 17,286 patients with CAD who had undergone PCI were screened for inclusion from the Grand-DES multi-center registry. We excluded patients whose prescription records of β-blockers were not available and those with non-continuous use of β-blockers during the follow-up period. Finally, a total of 3,075 patients with chronic CAD were included. After propensity score matching, a total of 1,170 pairs of patients were finally derived. CAD = coronary artery disease; DES = drug-eluting stent; PCI = percutaneous coronary intervention; PS = propensity score.

Figure 2. Clinical outcomes according to β-blocker therapy in matched population.

Among the matched population, the β-blocker group was not associated with better clinical outcomes in primary outcome, all-cause death, cardiac death, and MI compared with the no β-blocker group. CI = confidence interval; HR = hazard ratio; MI = myocardial infarction.

Figure 3. Subgroup analysis for primary outcome and all-cause death associated with β-blocker therapy.

There was no significant difference in primary outcome associated with β-blocker therapy across the various subgroups. β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/or revascularization. BES = Biolimus A9 eluting coronary stent; CHF = congestive heart failure; CI = confidence interval; DAPT = dual antiplatelet therapy; DES = drug-eluting stent; EES = Everolimus eluting coronary stent; HR = hazard ratio; LVEF = left ventricular ejection fraction; MI = myocardial infarction; ZES = Zotarolimus eluting coronary stent.

Figure 4. Clinical outcomes according to different doses of β-blockers.

After dose stratification, there was a dose-dependent tendency of lower risk of mortality with higher β-blockers doses, although the result was not statistically significant. CI = confidence interval; HR = hazard ratio; MI = myocardial infarction.

Figure 5. Clinical outcomes according to different types of β-blockers.

Compared with patients who received conventional β-blockers, those with vasodilating β-blockers were not associated with better clinical outcomes. CI = confidence interval; HR = hazard ratio; MI = myocardial infarction.