The long-term use of β-blockers increased the risk of cardiovascular events and other side effects in elderly patients with coronary artery disease (CAD) without a history of myocardial infarction (MI) or reduced ejection fraction (rEF), according to a presentation by Dr. Tatsuya Fukase of Juntendo University at the e-Abstract session of ACC 22.
The Long-Term Impact of β-Blockers for Secondary Prevention in Elderly Patients without Prior MI or rEF after PCI
The study included 1,018 CAD patients aged 60 years or older who underwent their first PCI at a single institution between 2010 and 2018. It excluded patients with rEF, patients undergoing hemodialysis, patients with prior heart failure (HF)/atrial fibrillation, and patients with a permanent pacemaker implantation. The long-term effects of β-blocker treatment were examined in 514 patients in the β-blocker group (50.5%) and 504 patients in the non-β-blocker group (49.5%).
Overall, the mean age of patients was 72 years, 77% were male, and the β-blocker group had higher triglyceride levels (132 mg/dL vs 120 mg/dL: p=0.002), lower EF (64.2% vs 65.8%: p=0.003), hypertension (100% vs 71%: p<0.001), and higher rates of chronic kidney disease (27% vs. 20%: p=0.016).
After a median follow-up of 5.1 years, all-cause mortality was not significantly different between the two groups, but the rate of MACE (cardiovascular death, nonfatal MI, nonfatal stroke, and heart failure hospitalization) was significantly higher in the β-blocker group and the non-β-blocker group (15.4% and 10.0%: p = 0.015). The heart failure hospitalization rate was also significantly higher in the β-blocker group (8.8% and 3.2%: p<0.001).
Multivariate analysis by Cox proportional hazard models confirmed the use of β-blockers (HR 2.71 [95%CI 1.06-8.32] p=0.038) and the difference between resting and exercise heart rates of 5 bpm (HR 0.74 [95%CI 0.55-0.96] p=0.025) as strong independent predictors of heart failure hospitalization.
Dr. Fukase summarized, “Long-term β-blocker use was significantly associated with an increased risk of adverse cardiovascular events in elderly patients with CAD without MI or rEF. In particular, the chronotropic incompetence action of β-blockers could increase the risk of hospitalization for HF in elderly CAD patients.”
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