Abstract 11031: Beta-Blocker Therapy is Associated with Worse 3-Year Clinical Outcomes in Patients who Underwent Percutaneous Coronary Intervention but No History of Myocardial Infarction or Heart Failure
Introduction: Patients with coronary artery disease (CAD) are at high risk for cardiac death or myocardial infarction (MI). We assessed the hypothesis that beta-blocker therapy improves long-term outcomes in patients with CAD who underwent percutaneous coronary intervention (PCI) but no history of MI or heart failure (HF).
Methods: In the CREDO-Kyoto registry cohort-2, a large multi-center registry in Japan enrolling consecuitive patients undergoing first coronary revascularization, we identified 5288 patients who did not have MI or HF but did have CAD and had undergone PCI. Three-year clinical outcomes were compared between the 2 groups of patients with (N = 1117) or without (N = 4171) oral beta-blocker prescription at discharge.
Results: Patients in the beta group more often had hypertension, diabetes mellitus, high body mass index, multivessel disease, chronic kidney disease, and atrial fibrillation but less often had chronic obstructive pulmonary disease than patients in the no-beta group. Usage of nitrates was less frequent in the beta group, while statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, nicorandil, and warfarin were more frequently prescribed in the beta group. The 3-year incidence of cardiac death/ MI was higher in the beta group than in the no-beta group (8.5% vs. 5.3%, log-rank p = 0.02). After adjusting for 36 potential confounders, including hypertension and diabetes mellitus, beta-blocker therapy was associated with significantly increased risk for cardiac death/MI (hazard ratio [HR] 1.44, 95% confidence interval [CI]: 1.02-2.01, p = 0.03), and non-significantly increased risk for cardiac death (HR 1.49, 95% CI: 0.79-2.71, p = 0.20), and MI (HR 1.39, 95% CI: 0.93-2.02, p = 0.09).
Conclusions: Beta-blocker therapy was associated with worse 3-year clinical outcomes in CAD patients who underwent PCI but no history of MI or HF.
- Coronary artery disease
- Percutaneous coronary intervention
- Evidence-based medicine
- © 2011 by American Heart Association, Inc.