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. 2024 Nov 21:11:1447952.
doi: 10.3389/fcvm.2024.1447952. eCollection 2024.

Beta-blockers after percutaneous coronary intervention for acute myocardial infarction and non-reduced left ventricular ejection fraction

Jun-Chang Jeong #  1 , Jong-Il Park #  1 , Byung-Jun Kim #  2 , Hong-Ju Kim  1 , Kang-Un Choi  1 , Jong-Ho Nam  1 , Chan-Hee Lee  1 , Jang-Won Son  1 , Jong-Seon Park  1 , Sung-Ho Her  3 , Ki-Yuk Chang  4 , Tae-Hoon Ahn  5 , Myung-Ho Jeong  6 , Seung-Woon Rha  7 , Hyo-Soo Kim  8 , Hyeon-Cheol Gwon  9 , In-Whan Seong  10 , Kyung-Kuk Hwang  11 , Seung-Ho Hur  12 , Kwang-Soo Cha  13 , Seok-Kyu Oh  14 , Jei-Keon Chae  15 , Ung Kim  1
Affiliations

Beta-blockers after percutaneous coronary intervention for acute myocardial infarction and non-reduced left ventricular ejection fraction

Jun-Chang Jeong et al. Front Cardiovasc Med. .

Abstract

Background: Data on the clinical impact of beta-blockers (BBs) in patients with myocardial infarction (MI) who had non-reduced left ventricular ejection fraction (LVEF) after percutaneous coronary intervention are limited.

Methods: From 2016 to 2020, we evaluated a cohort of 12,101 myocardial infarction patients with a non-reduced LVEF (≥40%) from the Korean Acute Myocardial Infarction Registry V. Patients were divided into two groups based on their BB (carvedilol, bisoprolol, or nebivolol) treatment at discharge: with beta-blocker treatment (BB, n = 9,468) and without beta-blocker treatment (non-BB, n = 2,633). The primary endpoint after discharge was the occurrence of patient-oriented composite endpoints (POCEs), including all-cause mortality, any MI, or any revascularization at 1-year follow-up.

Results: The median follow-up period was 353 days (interquartile range, 198-378 days). At 1-year follow-up, no significant differences were observed in the primary endpoint between the BB group and the non-BB group. Before propensity score (PS) matching, the POCE incidence was 3.1% in the BB group vs. 3.4% in the non-BB group [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.68-1.09, p = 0.225]. After PS matching, the POCE incidence remained similar between the two groups (3.7% vs. 3.4%, HR 1.01, 95% CI 0.76-1.35, p = 0.931). Individual outcomes, including all-cause mortality, myocardial infarction, and revascularization, also showed no significant differences between the two groups. Independent predictors of 1-year POCEs after discharge were age, chronic kidney disease, reduced LVEF, and multivessel disease.

Conclusion: BB treatment in patients with acute MI and non-reduced LVEF was not associated with a significant reduction in cardiovascular outcomes at 1-year follow-up.

Keywords: beta-blockers; left ventricular ejection fraction; myocardial infarction; patient-oriented composite endpoints; percutaneous coronary intervention.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study population. KAMIR V, Korean Acute Myocardial Infarction Registry V; LVEF, left ventricular ejection fraction; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Time-to-event curves for the primary endpoint according to beta-blocker treatment. Kaplan–Meier survival curves for POCEs at the 1-year follow-up (A) before propensity score matching and (B) after propensity score matching. POCEs, patient-oriented composite endpoints.
Figure 3
Figure 3
Time-to-event curves for the secondary endpoints according to beta-blocker use in the propensity score-matched population. Kaplan–Meier survival curves for (A) all-cause mortality, (B) any myocardial infarction, and (C) any revascularization. PCI, percutaneous coronary intervention.
Figure 4
Figure 4
Subgroup analysis for the primary endpoint at 1-year follow-up in the propensity score-matched population. BB, beta-blocker; CI, confidence interval; STEMI, ST-elevation myocardial infarction; NSTEMI, non-ST-elevation myocardial infarction.
See this image and copyright information in PMC

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