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CLINICAL STUDY: ADJUNCTIVE THERAPY AND PCI

Mortality benefit of beta-blockade after successful elective percutaneous coronary intervention

^* Section of Interventional Cardiology, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received December 30, 2001; revised manuscript received April 12, 2002, accepted May 15, 2002.

^* Reprint requests and correspondence: Dr. Stephen G. Ellis, Sones Cardiac Catheterization Laboratories, The Cleveland Clinic Foundation, 9500 Euclid Avenue, F25, Cleveland, Ohio 44195, USA.
elliss{at}ccf.org

OBJECTIVES: The goal of this study was to evaluate the mortality benefit of beta-blockers after successful percutaneous coronary intervention (PCI).

BACKGROUND: Beta-blockers reduce mortality after myocardial infarction (MI), though limited data are available regarding their role after successful PCI.

METHODS: Each year from 1993 through 1999, the first 1,000 consecutive patients undergoing PCI were systematically followed up. Patients presenting with acute or recent MI, shock, or unsuccessful revascularization procedures were excluded from the analysis. Clinical, procedural, and follow-up data of beta-blocker-treated and non-beta-blocker-treated patients were compared. A multivariate survival analysis model using propensity analysis was used to adjust for heterogeneity between the two groups.

RESULTS: Of the 4,553 patients, 2,056 (45%) were treated with beta-blockers at the time of the procedure. Beta-blocker therapy was associated with a mortality reduction from 1.3% to 0.8% at 30 days (p = 0.13) and a reduction from 6.0% to 3.9% at one year (p = 0.0014). This survival benefit of beta-blockers was independent of left ventricular function, diabetic status, history of hypertension, or history of MI. Using propensity analysis, beta-blocker therapy remained an independent predictor for one-year survival after PCI (hazard ratio, 0.63; 95% confidence interval, 0.46 to 0.87; p = 0.0054).

CONCLUSIONS: Within this large prospective registry, beta-blocker use was associated with a marked long-term survival benefit among patients undergoing successful elective percutaneous coronary revascularization.

Abbreviations and Acronyms   ACE   angiotensin-coverting enzyme   CABG   coronary artery bypass grafting   CAD   coronary artery disease   CI   confidence interval   CK   creatine kinase   COPD   chronic obstructive pulmonary disease   LVEF   left ventricular ejection fraction   MI   myocardial infarction   PCI   percutaneous coronary intervention

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