Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction

Khan, SU; Akbar, UA; Khan, MS; Patel, KV; Nadeem, A; Thakkar, S; Arshad, HB; Virani, SS; Nasir, K; Goel, SS; Shah, AR; Zoghbi, W; Kleiman, NS

doi:10.1016/j.jacadv.2024.101566

Coronary disease & ACS

Beta-Blockers After Percutaneous Coronary Intervention (PCI) for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction

JACC AdvPublished 17 Jan 2025retrospective cohort study

Main finding · All-cause mortalityResultHazard ratio 1.11 95% CI 1.09–1.18

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Authors' conclusion

Early beta-blocker initiation after PCI for stable CAD with preserved LVEF was associated with higher mortality, with no impact on cardiovascular events.

Study context

Population: Patients with stable coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF) after percutaneous coronary intervention (PCI), TriNetx database (2009–2024)matched patients per group
Participants: 11,681 patients

Exposure: Early beta-blocker initiation was compared with no initiation
Early beta-blocker initiationn = 11,681
No initiationn = 11,681reference
Outcome: All-cause mortality
Follow-up: 5 years

Methodological detailstarget trial emulation, incident user design, 1:1 greedy propensity score matching, intention-to-treat analysis

Target trial emulation
Incident user design
1:1 greedy propensity score matching
Intention-to-treat analysis

Main finding

As reported in the abstract

Hazard ratio

1.11

95% CI 1.09–1.18

Early beta-blocker initiationvs No initiation

HR 1.11 (95% CI 1.09–1.18)

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with early beta-blocker initiation ←→ Higher risk with early beta-blocker initiation →	HR (95% CI)
Hospitalization for myocardial infarction · 5 years	0.512	1.03 (0.97–1.09)
Stroke · 5 years	0.512	0.98 (0.91–1.05)
Heart failure · 5 years	0.512	0.99 (0.95–1.03)
Atrial fibrillation/flutter · 5 years	0.512	0.97 (0.93–1.01)
Falsification endpoint: hospitalization for bone fracture	0.512	1.02 (0.85–1.22)
Falsification endpoint: acute appendicitis	0.512	1.17 (0.95–1.45)
	0.512Hazard ratio (log scale)

Sensitivity analyses

Several sensitivity analyses showed consistent results

Safety

Outcome	← Lower risk with early beta-blocker initiation ←→ Higher risk with early beta-blocker initiation →	HR (95% CI)
Hospitalization for hypotensionHigher with beta-blockers	0.512	1.10 (1.06–1.14)
	0.512Hazard ratio (log scale)

Original publication

Beta-Blockers After PCI for Stable Coronary Artery Disease and Preserved Left Ventricular Ejection Fraction. JACC Adv. Published 17 January 2025. doi:10.1016/j.jacadv.2024.101566

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