Use of beta blockers following elective percutaneous coronary intervention (PCI) did not improve short-term or long-term cardiac outcomes, according to results from an observational analysis of elderly patients in the National Cardiovascular Data Registry CathPCI registry.
Findings were recently published in JACC: Cardiovascular Interventions.
Apurva A. Motivala, MD, of Columbia University in New York, New York and colleagues included 755 215 patients who were aged 65 years or older, and underwent elective PCI from 2005 to 2013 at one of the 1443 facilities participating in the registry. Patients with a prior history of myocardial infarction (MI), left ventricular systolic dysfunction, or systolic heart failure, prior coronary artery bypass graft, and documented contraindications to beta blockers were excluded.
Primary outcome was all-cause mortality at 30-day and 3-year follow-up. Seven in 10 patients were assigned to beta blockers at discharge.
At 30 days, researchers observed no differences in adjusted rates of hospitalization related to MI, hospitalization related to stroke, or revascularization for patients assigned to beta blockers and those who weren’t (0.9% vs 0.4%). Discharge on beta blockers was associated with more post-discharge rehospitalization related to heart failure (adjusted hazard ratio [HR]:1.70; 95% confidence interval [CI]: 1.43-2.02; P<.001).
A separate analysis of patients with only stable angina as a presenting symptom showed similar results but there were no differences in hospitalization related to heart failure (unadjusted HR: 0.6% vs 0.4%; adjusted HR: 1.34; 95% CI: 0.999-1.81; P<.051).
At 3 years of follow-up, unadjusted crude mortality rate was 13.8%, and researchers observed no difference in adjusted rates of mortality, hospitalization related to MI, and hospitalization related to stroke or revascularization between patients discharged with and without beta blockers.
Dr Motivala and colleagues noted that rates of heart failure related-hospitalization were higher in patients assigned beta blockers (adjusted HR: 1.18; 95% CI: 1.12-1.25; P<.001). Researchers found similar results when analyzing patients with only stable angina as a presenting symptom.
Motivala AA, Parikh V, Roe M, et al. Predictors, trends, and outcomes (among older patients ≥65 years of age) associated with beta-blocker use in patients with stable angina undergoing elective percutaneous coronary intervention. Insights from the NCDR Registry. JACC: Cardiovasc Interv. 2016;9:1639-1648. doi:10.1016/j.jcin.2016.05.048.