Beta-blockers failed to reduce mortality in patients with stable angina
CHICAGO — Beta-blocker use at discharge in patients with stable angina without prior history of MI or systolic HF undergoing elective PCI did not affect mortality at 30 days or 3 years, according to findings presented at the American Heart Association Scientific Sessions.
Valay Parikh, MD, from Staten Island University Hospital in New York, and colleagues evaluated CV outcomes associated with beta-blocker use in patients with stable angina without prior history of MI or systolic HF who underwent elective PCI.
“Beta-blockers are considered an integral part of optimal medical therapy for this population,” Parikh said. “However, the evidence supporting its use in patients without heart failure or history of MI is limited. The data supporting its use is mainly from patients without complete revascularization.”
The primary endpoints of the trial were all-cause mortality, revascularization or hospitalization related to MI, HF or stroke. The secondary endpoint was a composite of mortality, revascularization and hospitalization related to MI, HF or stroke. Outcomes were assessed at 30 days and 3 years.
The analysis included 245,097 patients (mean age, 65 years) treated from 2005 to 2013 at 1,032 US sites. Patients discharged on beta-blockers were more likely to be younger; female; having a history of hypertension, diabetes, dyslipidemia, smoking, dialysis, prior PCI or prior HF; present with a higher NYHA HF class; have American College of Cardiology/AHA type C lesions; have undergone multivessel PCI; and have acute PCI complications and urgent PCI. Patients discharged on beta-blockers were less likely to have chronic lung disease.
From 2005 to 2013, Parikh reported a gradual increase in beta-blocker use.
Thirty-day results indicated that the HR for all-cause mortality associated with beta-blocker use at discharge was 0.86 (P=.08). Additional 30-day data associated with beta-blocker use at discharge demonstrated HRs of 1.13 for MI (P=.24); 1.07 for stroke (P=.72); 1.7 for HF; 0.94 for revascularization; 1.2 for mortality, MI, stroke or HF (P<.01); and 0.94 for mortality, MI, stroke or revascularization. A 30-day increase in HF was associated with beta-blocker use at discharge (HR=1.7; P<.01).
“We noticed similar results in the long-term,” Parikh said.
At 3 years, beta-blocker use at discharge did not affect all-cause mortality (HR=1; P=.84); MI (HR=1; P=.91); stroke (HR=1.08; P=.14); revascularization (HR=0.97; P=.1); or mortality, MI, stroke or revascularization (HR=0.99; P=.31). However, the researchers observed an increase in HF (HR=1.18; P<.01) and mortality, MI, stroke or HF (HR=1.04; P=.01).
“Beta-blocker use at discharge in patients with stable angina without prior history of MI or systolic HF undergoing elective PCI was not associated with any decrease in mortality, revascularization and rehospitalization related to MI or stroke at 30-days and 3-years follow-up,” Parikh concluded. “Over time, prescriptions of beta-blockers at discharge have continued to increase in this population despite of lack of clearly demonstrated objective benefits.”
According to Parikh, specific patient and procedural characteristics have influenced prescriptions of beta-blockers at discharge in this population. Some of the reasons for this include complete revascularization, poor compliance, poor effects of antihypertensive drugs, issues related to guidelines and suboptimal dosing.
“Increasing adherence to guidelines based therapies and various initiatives such as the National Cardiovascular Data Registry facilitating maximal optimal medical therapy usage may be contributory,” Parikh said.
For more information:
Parikh V. Abstract #15865. Presented at: American Heart Association Scientific Sessions; Nov. 15-19, 2014; Chicago.
Disclosure: The researchers report associations with the National Cardiovascular Data Registry.