Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction
Background: 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). Objectives: The aim of the study was to evaluate the effects of...
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Elsevier
2025-02-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X24008470 |
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| author | Safi U. Khan, MD, MS Usman Ali Akbar, MD Muhammad Shahzeb Khan, MD Kershaw V. Patel, MD Amna Nadeem, MBBS Samarth Thakkar, MD Hassaan B. Arshad, MD Salim S. Virani, MD, PhD Khurram Nasir, MD, MPH Sachin S. Goel, MD Alpesh R. Shah, MD William Zoghbi, MD Neal S. Kleiman, MD |
| author_facet | Safi U. Khan, MD, MS Usman Ali Akbar, MD Muhammad Shahzeb Khan, MD Kershaw V. Patel, MD Amna Nadeem, MBBS Samarth Thakkar, MD Hassaan B. Arshad, MD Salim S. Virani, MD, PhD Khurram Nasir, MD, MPH Sachin S. Goel, MD Alpesh R. Shah, MD William Zoghbi, MD Neal S. Kleiman, MD |
| author_sort | Safi U. Khan, MD, MS |
| collection | DOAJ |
| description | Background: 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). Objectives: 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. Methods: 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. Results: 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. Conclusions: Early beta-blocker initiation after PCI for stable CAD with preserved LVEF was associated with higher mortality, with no impact on cardiovascular events. |
| format | Article |
| id | doaj-art-a95ec5c077f34d0b8eecd0c0c4631deb |
| institution | Kabale University |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-a95ec5c077f34d0b8eecd0c0c4631deb2025-01-19T06:26:59ZengElsevierJACC: Advances2772-963X2025-02-0142101566Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection FractionSafi U. Khan, MD, MS0Usman Ali Akbar, MD1Muhammad Shahzeb Khan, MD2Kershaw V. Patel, MD3Amna Nadeem, MBBS4Samarth Thakkar, MD5Hassaan B. Arshad, MD6Salim S. Virani, MD, PhD7Khurram Nasir, MD, MPH8Sachin S. Goel, MD9Alpesh R. Shah, MD10William Zoghbi, MD11Neal S. Kleiman, MD12Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Address for correspondence: Dr Safi U. Khan, Department of Cardiology, Houston Methodist, DeBakey Heart & Vascular Center, Houston, Texas 77030, USA.West Virginia University- Camden Clark Medical Center, Parkersburg, West Virginia, USADivision of Cardiology, Duke University School of Medicine, Durham, North Carolina, USADepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USADepartment of Medicine, Punjab Medical College, Faisalabad, PakistanDepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USADepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USADepartment of Medicine, The Aga Khan University, Karachi, Pakistan; Baylor College of Medicine, Texas Heart Institute, Houston, Texas, USADepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USADepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USADepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USADepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USADepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USABackground: 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). Objectives: 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. Methods: 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. Results: 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. Conclusions: Early beta-blocker initiation after PCI for stable CAD with preserved LVEF was associated with higher mortality, with no impact on cardiovascular events.http://www.sciencedirect.com/science/article/pii/S2772963X24008470beta-blockerpercutaneous coronary interventionstable ischemic heart diseasetarget-trial emulation |
| spellingShingle | Safi U. Khan, MD, MS Usman Ali Akbar, MD Muhammad Shahzeb Khan, MD Kershaw V. Patel, MD Amna Nadeem, MBBS Samarth Thakkar, MD Hassaan B. Arshad, MD Salim S. Virani, MD, PhD Khurram Nasir, MD, MPH Sachin S. Goel, MD Alpesh R. Shah, MD William Zoghbi, MD Neal S. Kleiman, MD Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction JACC: Advances beta-blocker percutaneous coronary intervention stable ischemic heart disease target-trial emulation |
| title | Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction |
| title_full | Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction |
| title_fullStr | Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction |
| title_full_unstemmed | Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction |
| title_short | Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction |
| title_sort | beta blockers after pci for stable coronary artery disease and preserved left ventricular ejection fraction |
| topic | beta-blocker percutaneous coronary intervention stable ischemic heart disease target-trial emulation |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X24008470 |
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