This study examines predictors and outcomes associated with the prescription of beta-blockers at discharge after a successful coronary angioplasty in patients with stable chronic angina WITHOUT prior history of acute myocardial infarction or heart failure.
The benefit of beta-blockers in patients with acute myocardial infarction or systolic heart failure is well documented. However, their benefits in patients with stable chronic angina, particularly those who have undergone an angioplasty, remain unclear.
This study included patients with stable chronic angina without prior history of myocardial infarction, left ventricular dysfunction (ejection fraction <40%), or systolic heart failure who underwent an elective angioplasty between January 2005 and March 2013.
These patients were retrospectively analyzed regarding beta-blocker prescription at discharge.
All-cause mortality was analyzed (primary endpoint), as well as the following:
- Revascularization.
- Hospitalization due to acute myocardial infarction.
- Heart failure or stroke at 30 days.
- Heart failure or stroke at 3 years in patients ≥65 years old.
A total of 755,215 patients were enrolled; 71.4% were discharged on beta-blockers.
At 3 years, no differences were observed in patients who had been prescribed beta-blockers, as regards the following:
- Adjusted mortality rate (14.0% vs. 13.3%; hazard ratio [HR]: 1.00; 95% confidence interval [CI]: 0.96 to 1.03; p = 0.84).
- Myocardial infarction (4.2% vs. 3.9%; HR: 1.00; 95% CI: 0.93 to 1.07; p = 0.92).
- Stroke (2.3% vs. 2.0%; HR: 1.08; 95% CI: 0.98 to 1.18; p = 0.14).
- Revascularization (18.2% vs. 17.8%; HR: 0.97; 95% CI: 0.94 to 1.01; p = 0.10).
However, a higher rate of hospital readmissions due to heart failure was indeed observed in patients discharged on a treatment with beta-blockers (8.0% vs. 6.1%; HR: 1.18; 95% CI: 1.12 to 1.25; p < 0.001).
During the period between 2005 and 2013, there was a gradual increase in the prescription of beta-blockers in this cohort.
Conclusion
The prescription of beta-blockers at discharge after an elective angioplasty in patients ≥65 years old with stable chronic angina and without prior history of myocardial infarction, heart failure, or ejection fraction <40% was not associated with any reduction in events at 30 days or 3 years. However, the prescription of beta-blockers in this population continued to increase over time.
Original title: Predictors, Trends, and Outcomes (Among Older Patients ≥65 Years of Age) Associated With Beta-Blocker Use in Patients With Stable Angina Undergoing Elective Percutaneous Coronary Intervention. Insights From the NCDR Registry.
Reference: Apurva A et al. J Am Coll Cardiol Intv. 2016;9(16):1639-1648.
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