Mortality benefit of beta-blockade after successful elective percutaneous coronary intervention.
OBJECTIVE
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.
Section of Interventional Cardiology, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Albert W
AW
Chan
Martin J
MJ
Quinn
Deepak L
DL
Bhatt
Derek P
DP
Chew
David J
DJ
Moliterno
Eric J
EJ
Topol
Stephen G
SG
Ellis
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D016019:Survival Analysis
D000319:Adrenergic beta-Antagonists