Khan Safi U, Akbar Usman Ali, Khan Muhammad Shahzeb, Patel Kershaw V, Nadeem Amna, Thakkar Samarth, Arshad Hassaan B, Virani Salim S, Nasir Khurram, Goel Sachin S, Shah Alpesh R, Zoghbi William, Kleiman Neal S
Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA. Electronic address: https://twitter.com/safinmc.
West Virginia University- Camden Clark Medical Center, Parkersburg, West Virginia, USA.
JACC Adv. 2025 Feb;4(2):101566. doi: 10.1016/j.jacadv.2024.101566. Epub 2025 Jan 17.
Limited data exist on the long-term impact of beta-blocker therapy after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF).
The aim of the study was to evaluate the effects of early beta-blocker initiation vs no initiation following PCI in patients with stable CAD and preserved LVEF.
This retrospective cohort study employed target trial emulation and incident user design, utilizing the TriNetx database (2009-2024). Early beta-blocker initiation (within days 1 and 7) was compared with no initiation using 1:1 greedy propensity score matching. The outcomes included all-cause mortality, hospitalization for myocardial infarction, heart failure, atrial fibrillation/flutter, stroke, and safety endpoints. Hospitalization for bone fracture and acute appendicitis served as falsification endpoints. In the intention-to-treat analysis, outcomes were analyzed over 5 years using Cox-proportional hazards.
Out of 11,681 matched patients per group, beta-blocker therapy was associated with increased all-cause mortality (HR: 1.11 [95% CI: 1.09-1.18]). No significant differences were found in hospitalization for myocardial infarction (HR: 1.03 [95% CI: 0.97-1.09]), stroke (HR: 0.98 [95% CI: 0.91-1.05]), heart failure (HR: 0.99 [95% CI: 0.95-1.03]), and atrial fibrillation/flutter (HR: 0.97 [95% CI: 0.93-1.01]). Hospitalization for hypotension was higher with beta-blockers (HR: 1.10 [95% CI: 1.06-1.14]). Hospitalization for bone fracture (HR: 1.02 [95% CI: 0.85-1.22]) and acute appendicitis (HR: 1.17 [95% CI: 0.95-1.45]) showed no significant associations. Several sensitivity analyses showed consistent results.
Early beta-blocker initiation after PCI for stable CAD with preserved LVEF was associated with higher mortality, with no impact on cardiovascular events.
关于经皮冠状动脉介入治疗（PCI）后β受体阻滞剂治疗对稳定型冠状动脉疾病（CAD）且左心室射血分数（LVEF）保留患者的长期影响的数据有限。
本研究旨在评估PCI后早期开始使用β受体阻滞剂与不使用β受体阻滞剂对稳定型CAD且LVEF保留患者的影响。
这项回顾性队列研究采用目标试验模拟和事件使用者设计，利用TriNetx数据库（2009 - 2024年）。使用1:1贪婪倾向评分匹配将早期β受体阻滞剂起始治疗（在第1天和第7天内）与未起始治疗进行比较。结局包括全因死亡率、心肌梗死住院、心力衰竭、心房颤动/扑动、中风和安全性终点。骨折住院和急性阑尾炎住院作为伪造终点。在意向性分析中，使用Cox比例风险模型对5年的结局进行分析。
每组11,681例匹配患者中，β受体阻滞剂治疗与全因死亡率增加相关（风险比：1.11 [95%置信区间：1.09 - 1.18]）。在心肌梗死住院（风险比：1.03 [95%置信区间：0.97 - 1.09]）、中风（风险比：0.98 [95%置信区间：0.91 - 1.05]）、心力衰竭（风险比：0.99 [95%置信区间：0.95 - 1.03]）和心房颤动/扑动（风险比：0.97 [95%置信区间：0.93 - 1.01]）方面未发现显著差异。使用β受体阻滞剂时低血压住院率更高（风险比：1.10 [95%置信区间：1.06 - 1.14]）。骨折住院（风险比：1.02 [95%置信区间：0.85 - 1.22]）和急性阑尾炎住院（风险比：1.17 [95%置信区间：0.95 - 1.45]）未显示出显著相关性。多项敏感性分析显示结果一致。
对于LVEF保留的稳定型CAD患者，PCI后早期起始β受体阻滞剂治疗与较高死亡率相关，对心血管事件无影响。
