This is another study that concludes that beta-blockers have no impact on mortality at 1 year after infarction in stable patients and offer no survival benefit to patients with stable ischemic heart disease who have not experienced a myocardial infarction.
This analysis represents 5 years of follow-up in a large, multinational registry and also shows a lack of benefit derived from calcium channel blockers.
These drugs should be indicated as symptomatic treatment in patients with stable coronary disease, with or without a history of infarction, but without expecting a reduction in mortality.
Regarding this point, guidelines are different on each side of the Atlantic. While European guidelines recommend both beta-blockers or calcium channel blockers as first-line therapy for symptom relief in patients with stable chronic angina, American guidelines recommend beta-blockers preferentially, leaving calcium channel blockers to be used when beta-blockers are contraindicated or cause unacceptable side effects.
The CLARIFY registry included patients from 45 countries who were treated between 2009 and 2010, and then followed them for 5 years. Among them, 22,006 patients received beta-blockers and 22,004 received calcium channel blockers. To be included, patients had to meet at least one of the following conditions: prior infarction (>3 months), prior revascularization (>3 months), proven symptomatic myocardial ischemia, or angiographic lesions >50%.
At 5 years, there were no differences in the rates of all-cause death (the primary endpoint) or of cardiovascular death plus non-fatal infarction.
Original title: CLARIFY: First-Line Anti-Ischemic Agents Use and Long-Term Clinical Outcomes in Stable Coronary Artery Disease.
Presenter: Sorbets E. at the European Society of Cardiology 2018 Congress in Munich.
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