title: β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease.
abstract: BACKGROUND
  β-Blockers remain the standard of care after a myocardial infarction (MI). However, the benefit of β-blocker use in patients with coronary artery disease (CAD) but no history of MI, those with a remote history of MI, and those with only risk factors for CAD is unclear.
  
  
  OBJECTIVE
  To assess the association of β-blocker use with cardiovascular events in stable patients with a prior history of MI, in those with CAD but no history of MI, and in those with only risk factors for CAD.
  
  
  METHODS
  Longitudinal, observational study of patients in the Reduction of Atherothrombosis for Continued Health (REACH) registry who were divided into 3 cohorts: known prior MI (n = 14,043), known CAD without MI (n = 12,012), or those with CAD risk factors only (n = 18,653). Propensity score matching was used for the primary analyses. The last follow-up data collection was April 2009.
  
  
  METHODS
  The primary outcome was a composite of cardiovascular death, nonfatal MI, or nonfatal stroke. The secondary outcome was the primary outcome plus hospitalization for atherothrombotic events or a revascularization procedure.
  
  
  RESULTS
  Among the 44,708 patients, 21,860 were included in the propensity score-matched analysis. With a median follow-up of 44 months (interquartile range, 35-45 months), event rates were not significantly different in patients with β-blocker use compared with those without β-blocker use for any of the outcomes tested, even in the prior MI cohort (489 [16.93%] vs 532 [18.60%], respectively; hazard ratio [HR], 0.90 [95% CI, 0.79-1.03]; P = .14). In the CAD without MI cohort, the associated event rates were not significantly different in those with β-blocker use for the primary outcome (391 [12.94%]) vs without β-blocker use (405 [13.55%]) (HR, 0.92 [95% CI, 0.79-1.08]; P = .31), with higher rates for the secondary outcome (1101 [30.59%] vs 1002 [27.84%]; odds ratio [OR], 1.14 [95% CI, 1.03-1.27]; P = .01) and for the tertiary outcome of hospitalization (870 [24.17%] vs 773 [21.48%]; OR, 1.17 [95% CI, 1.04-1.30]; P = .01). In the cohort with CAD risk factors only, the event rates were higher for the primary outcome with β-blocker use (467 [14.22%]) vs without β-blocker use (403 [12.11%]) (HR, 1.18 [95% CI, 1.02-1.36]; P = .02), for the secondary outcome (870 [22.01%] vs 797 [20.17%]; OR, 1.12 [95% CI, 1.00-1.24]; P = .04) but not for the tertiary outcomes of MI (89 [2.82%] vs 68 [2.00%]; HR, 1.36 [95% CI, 0.97-1.90]; P = .08) and stroke (210 [6.55%] vs 168 [5.12%]; HR, 1.22 [95% CI, 0.99-1.52]; P = .06). However, in those with recent MI (≤1 year), β-blocker use was associated with a lower incidence of the secondary outcome (OR, 0.77 [95% CI, 0.64-0.92]).
  
  
  CONCLUSIONS
  In this observational study of patients with either CAD risk factors only, known prior MI, or known CAD without MI, the use of β-blockers was not associated with a lower risk of composite cardiovascular events.
authors.affiliation: Cardiovascular Clinical Research Center, New York University School of Medicine, 550 First Ave, New York, NY 10016, USA. sripalbangalore@gmail.com
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.forename: Gabriel
authors.initials: G
authors.lastname: Steg
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.forename: Kevin
authors.initials: K
authors.lastname: Crowley
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Elaine B
authors.initials: EB
authors.lastname: Hoffman
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D057216:Propensity Score; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists