Document Detail

β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease.
MedLine Citation:
PMID:  23032550     Owner:  NLM     Status:  MEDLINE    
CONTEXT: β-Blockers remain the standard of care after a myocardial infarction (MI). However, the benefit of β-blocker use in patients with coronary artery disease (CAD) but no history of MI, those with a remote history of MI, and those with only risk factors for CAD is unclear.
OBJECTIVE: To assess the association of β-blocker use with cardiovascular events in stable patients with a prior history of MI, in those with CAD but no history of MI, and in those with only risk factors for CAD.
DESIGN, SETTING, AND PATIENTS: Longitudinal, observational study of patients in the Reduction of Atherothrombosis for Continued Health (REACH) registry who were divided into 3 cohorts: known prior MI (n = 14,043), known CAD without MI (n = 12,012), or those with CAD risk factors only (n = 18,653). Propensity score matching was used for the primary analyses. The last follow-up data collection was April 2009.
MAIN OUTCOME MEASURES: The primary outcome was a composite of cardiovascular death, nonfatal MI, or nonfatal stroke. The secondary outcome was the primary outcome plus hospitalization for atherothrombotic events or a revascularization procedure.
RESULTS: Among the 44,708 patients, 21,860 were included in the propensity score-matched analysis. With a median follow-up of 44 months (interquartile range, 35-45 months), event rates were not significantly different in patients with β-blocker use compared with those without β-blocker use for any of the outcomes tested, even in the prior MI cohort (489 [16.93%] vs 532 [18.60%], respectively; hazard ratio [HR], 0.90 [95% CI, 0.79-1.03]; P = .14). In the CAD without MI cohort, the associated event rates were not significantly different in those with β-blocker use for the primary outcome (391 [12.94%]) vs without β-blocker use (405 [13.55%]) (HR, 0.92 [95% CI, 0.79-1.08]; P = .31), with higher rates for the secondary outcome (1101 [30.59%] vs 1002 [27.84%]; odds ratio [OR], 1.14 [95% CI, 1.03-1.27]; P = .01) and for the tertiary outcome of hospitalization (870 [24.17%] vs 773 [21.48%]; OR, 1.17 [95% CI, 1.04-1.30]; P = .01). In the cohort with CAD risk factors only, the event rates were higher for the primary outcome with β-blocker use (467 [14.22%]) vs without β-blocker use (403 [12.11%]) (HR, 1.18 [95% CI, 1.02-1.36]; P = .02), for the secondary outcome (870 [22.01%] vs 797 [20.17%]; OR, 1.12 [95% CI, 1.00-1.24]; P = .04) but not for the tertiary outcomes of MI (89 [2.82%] vs 68 [2.00%]; HR, 1.36 [95% CI, 0.97-1.90]; P = .08) and stroke (210 [6.55%] vs 168 [5.12%]; HR, 1.22 [95% CI, 0.99-1.52]; P = .06). However, in those with recent MI (≤1 year), β-blocker use was associated with a lower incidence of the secondary outcome (OR, 0.77 [95% CI, 0.64-0.92]).
CONCLUSION: In this observational study of patients with either CAD risk factors only, known prior MI, or known CAD without MI, the use of β-blockers was not associated with a lower risk of composite cardiovascular events.
Sripal Bangalore; Gabriel Steg; Prakash Deedwania; Kevin Crowley; Kim A Eagle; Shinya Goto; E Magnus Ohman; Christopher P Cannon; Sidney C Smith; Uwe Zeymer; Elaine B Hoffman; Franz H Messerli; Deepak L Bhatt;
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  308     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-03     Completed Date:  2012-10-09     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1340-9     Citation Subset:  AIM; IM    
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Cardiovascular Diseases / mortality*,  prevention & control
Coronary Artery Disease / drug therapy*,  mortality*
Hospitalization / statistics & numerical data
Longitudinal Studies
Middle Aged
Myocardial Infarction / drug therapy*
Myocardial Revascularization / statistics & numerical data
Propensity Score
Risk Factors
Stroke / epidemiology
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Comment In:
JAMA. 2013 Feb 6;309(5):439-40   [PMID:  23385261 ]
JAMA. 2013 Feb 6;309(5):439   [PMID:  23385260 ]
JAMA. 2013 Feb 6;309(5):438-9   [PMID:  23385259 ]
Expert Rev Cardiovasc Ther. 2013 Mar;11(3):289-91   [PMID:  23469908 ]
JAMA. 2013 Feb 6;309(5):438   [PMID:  23385258 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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