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Coronary artery disease
Original research
Role of beta blockers following percutaneous coronary intervention for acute coronary syndrome
  1. Kah Yong Peck1,2,
  2. Nick Andrianopoulos3,
  3. Diem Dinh3,
  4. Louise Roberts1,2,
  5. Stephen J Duffy3,4,
  6. Martin Sebastian5,
  7. David Clark6,
  8. Angela Brennan3,
  9. Ernesto Oqueli7,8,
  10. Andrew E Ajani9,
  11. Christopher M Reid3,10,
  12. Melanie Freeman1,
  13. Andrew W Teh1,2,6
  1. 1 Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia
  2. 2 Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
  3. 3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4 Department of Cardiovascular Medicine, Alfred Health, The Alfred Hospital, Melbourne, Victoria, Australia
  5. 5 Department of Cardiology, Barwon Health, University Hospital, Geelong, Victoria, Australia
  6. 6 Department of Cardiology, The University of Melbourne, Austin Hospital Clinical School, Melbourne, Victoria, Australia
  7. 7 Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
  8. 8 School of Medicine, Deakin University, Ballarat, Victoria, Australia
  9. 9 Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
  10. 10 School of Public Health, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Associate Professor Andrew W Teh, Department of Cardiology, Box Hill Hospital, Box Hill, Victoria, Australia; andrew.teh{at}easternhealth.org.au

Abstract

Aims There is a paucity of evidence supporting routine beta blocker (BB) use in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). The aim of this study was to evaluate BB use post PCI and its association with mortality. Furthermore, the study aimed to evaluate the association between BB and mortality in the subgroups of patients with left ventricular ejection fraction (LVEF) <35%, LVEF 35%–50% and LVEF >50%.

Methods Using a large PCI registry, data from patients with ACS between January 2005 and June 2017 who were alive at 30 days were analysed. Those patients taking BB at 30 days were compared with those who were not taking BB. The primary outcome was all-cause mortality. The mean follow-up was 5.3±3.5 years.

Results Of the 17 562 patients, 83.3% were on BB. Mortality was lower in the BB group (13.1% vs 19.5%, p=0.0001). Multivariable Cox proportional hazards model showed that BB use was associated with lower overall mortality (adjusted HR 0.87, 95% CI 0.78 to 0.97, p=0.014). In the subgroup analysis, BB use was associated with reduced mortality in LVEF <35% (adjusted HR 0.63, 95% CI 0.44 to 0.91, p=0.013), LVEF 35%–50% (adjusted HR 0.80, 95% CI 0.68 to 0.95, p=0.01), but not LVEF >50% (adjusted HR 1.03, 95% CI 0.87 to 1.21, p=0.74).

Conclusion BB use remains high and is associated with reduced mortality. This reduction in mortality is primarily seen in those with reduced ejection fraction, but not in those with preserved ejection fraction.

  • acute myocardial infarction
  • percutaneous coronary intervention

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data are obtained from the Melbourne Interventional Group (MIG) registry.

https://doi.org/10.1136/heartjnl-2020-316605

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Data are obtained from the Melbourne Interventional Group (MIG) registry.

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    Footnotes

    • Contributors KYP and AWT were involved in the conception and design of the study, acquisition of data, analysis and interpretation of data, and drafting of the article. They are responsible for the overall content as guarantors. NA and DD were responsible for the analysis, interpretation of data and drafting of the manuscript. LR, SJD, MS, DC, AB, EO, AEA, CMR and MF were responsible for the acquisition of registry data from various hospitals and drafting of the manuscript.

    • Funding The Melbourne Interventional Group is supported by Abbott, AstraZeneca, Medtronic, MSD, Pfizer, Servier and The Medicines Company.

    • Competing interests SJD reports grants from the National Health and Medical Research Council of Australia, during the conduct of the study.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.