Lee Seung-Jun, Choi Dong-Woo, Kim Choongki, Suh Yongsung, Hong Sung-Jin, Ahn Chul-Min, Kim Jung-Sun, Kim Byeong-Keuk, Ko Young-Guk, Choi Donghoon, Park Eun-Cheol, Jang Yangsoo, Nam Chung-Mo, Hong Myeong-Ki
Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Front Cardiovasc Med. 2022 May 17;9:878003. doi: 10.3389/fcvm.2022.878003. eCollection 2022.
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).
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.
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, < 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, = 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.
Among patients with stable CAD undergoing DES implantation, long-term maintenance with beta-blocker treatment might not be associated with clinical outcome improvement.
ClinicalTrial.gov (NCT04715594).
对于接受经皮冠状动脉介入治疗（PCI）的稳定型冠状动脉疾病（CAD）患者，β受体阻滞剂治疗是否有益尚不清楚。我们评估了药物洗脱支架（DES）植入术后长期维持使用β受体阻滞剂对稳定型CAD患者的临床影响。
从全国队列数据库中，我们确定了无心肌梗死或心力衰竭当前或既往病史且接受DES植入的稳定型CAD患者。采用意向性分析原则来分析β受体阻滞剂治疗对由心血管死亡、心肌梗死和心力衰竭住院组成的主要不良心血管事件（MACE）长期结局的影响。
在稳定治疗权重的逆概率后，共纳入78380例稳定型CAD患者；45746例接受β受体阻滞剂治疗，32634例未接受。在PCI术后5年且有6个月隔离期时，意向性分析中接受β受体阻滞剂治疗的患者MACE调整发病率显著更高[10.0%对9.1%；风险比（HR）1.11，95%置信区间1.06 - 1.16，<0.001]。接受和未接受β受体阻滞剂治疗的患者全因死亡无显著差异（8.1%对8.2%；HR 0.99，95%置信区间0.94 - 1.04，=0.62）。时变Cox回归和秩保留结构失效时间模型的统计分析显示结果与意向性分析相似。
在接受DES植入的稳定型CAD患者中，长期维持β受体阻滞剂治疗可能与临床结局改善无关。
ClinicalTrial.gov（NCT04715594）
