Optimal Dose and Type of β-blockers in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Jiesuck Park, Jung Kyu Han, Jeehoon Kang, In Ho Chae, Sung Yun Lee, Young Jin Choi, Jay Young Rhew, Seung Woon Rha, Eun Seok Shin, Seong Ill Woo, Han Cheol Lee, Kook Jin Chun, Doo Il Kim, Jin Ok Jeong, Jang Whan Bae, Han Mo Yang, Kyung Woo Park, Hyun Jae Kang, Bon Kwon Koo, Hyo Soo Kim

Research output: Contribution to journalArticlepeer-review

Abstract

The clinical benefit of β-blockers in modern reperfusion era is not well determined. We investigated the impact of β-blockers in acute coronary syndrome (ACS) after percutaneous coronary intervention. From the Grand-DES registry, a patient-level pooled registry consisting of 5 Korean multicenter prospective drug-eluting stent registries, a total of 6,690 ACS patients were included. Prescription records of dose and type of β-blockers were investigated trimonthly from discharge. Patients were categorized by the mean value of doses during the follow-up (≥50% [high-dose], ≥25% to <50% [medium-dose], and <25% [low-dose] of the full dose that was used in each randomized clinical trial) and vasodilating property of β-blockers. Three-year cumulative risk of all-cause death, cardiac death, and myocardial infarction were assessed. Patients receiving β-blockers were associated with a lower risk of all-cause and cardiac death compared with those not receiving β-blockers (adjusted hazard ratio [aHR] 0.29, 95% confidence interval [CI] 0.24 to 0.35 for all-cause death; aHR 0.27, 95% CI 0.21 to 0.34 for cardiac death). Medium-dose β-blocker group was associated with a lower risk of cardiac death compared with high- and low-dose β-blocker groups (aHR 0.49, 95% CI 0.25 to 0.96, for high-dose; aHR 0.46, 95% CI 0.29 to 0.74, for low-dose). Patients receiving vasodilating β-blockers were associated with a lower risk of cardiac death compared with those receiving conventional β-blockers (aHR 0.58, 95% CI 0.40 to 0.84). In conclusion, β-blocker therapy was associated with better clinical outcomes in patients with ACS, especially with medium-dose and vasodilating β-blockers.

Original languageEnglish
JournalAmerican Journal of Cardiology
DOIs
Publication statusAccepted/In press - 2020

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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