Effect of pre-procedural beta-blocker on clinical outcome after percutaneous coronary intervention in acute coronary syndrome from the 2014 k-pci registry

Bum Sung Kim, Sang Youg Eom, Sung Hea Kim, Hweung Kon Hwang, Jong Seon Park, Weon Kim, Jun Won Lee, Seung Woon Rha, Geon Young Kim, Sang Wook Lim, Su Hun Lee, Jei Keon Chae, Seong Ill Woo, Jang Whan Bae, Hyun Joong Kim

Research output: Contribution to journalArticle

Abstract

The efficacy of pre-procedural beta-blocker use in patients with acute coronary syndrome (ACS) is not well established in the current percutaneous coronary intervention (PCI) era. We investigate the effect of pre-procedural beta-blocker use on clinical outcomes in patients with ACS undergoing PCI. Among 44,967 consecutive cases of PCI enrolled in the nationwide, retrospective, multicenter registry (K-PCI registry), 31,040 patients with ACS were selected and analyzed. We classified patients into pre-procedural beta-blocker group (n = 8,678) and pre-procedural no-beta-blocker group (n = 22,362) according to the use of beta-blockers at least for two weeks before index PCI. Propensity score-matching analysis was performed and resulted in 7,445 pairs. The primary outcome was in-hospital cardiac death. In propensity score-matched populations, the pre-procedural beta-blocker group had a lower incidence of in-hospital cardiac death compared with the pre-procedural no-beta-blocker group (1.1% versus 2.0%, unadjusted odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.42-0.73, P < 0.01). In subgroup analysis, the pre-procedural beta-blocker group had a lower incidence of in-hospital cardiac death, compared with the pre-procedural no-beta-blocker group in ST-segment elevation myocardial infarction subpopulation (3.1% versus 6.1%, unadjusted OR: 0.49, 95% CI: 0.34-0.71, P < 0.01) and non-ST-segment elevation myocardial infarction subpopulation (1.5% versus 2.9%, unadjusted OR: 0.51, 95% CI: 0.33-0.79, P < 0.01). However, in unstable angina subpopulation, the in-hospital cardiac death rate was comparable between both groups. In conclusion, the use of pre-procedural beta-blocker was associated with a lower risk of in-hospital cardiac death in patients with ACS undergoing PCI. This result adds to the body of evidence that use of pre-procedural beta-blocker in patients with ACS might be reasonable.

Original languageEnglish
Pages (from-to)1284-1292
Number of pages9
JournalInternational Heart Journal
Volume60
Issue number6
DOIs
Publication statusPublished - 2019 Jan 1

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Keywords

  • Cardiac death
  • Coronary artery disease
  • Pre-procedural medication

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kim, B. S., Eom, S. Y., Kim, S. H., Hwang, H. K., Park, J. S., Kim, W., Lee, J. W., Rha, S. W., Kim, G. Y., Lim, S. W., Lee, S. H., Chae, J. K., Woo, S. I., Bae, J. W., & Kim, H. J. (2019). Effect of pre-procedural beta-blocker on clinical outcome after percutaneous coronary intervention in acute coronary syndrome from the 2014 k-pci registry. International Heart Journal, 60(6), 1284-1292. https://doi.org/10.1536/ihj.19-175