title: Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery.
abstract: BACKGROUND
  Conflicting results from recent observational studies have raised questions concerning the benefit of β-blockers for patients undergoing coronary artery bypass grafting (CABG). Furthermore, the efficacy of long-term β-blocker therapy in CABG patients after hospital discharge is uncertain.
  
  
  RESULTS
  The study included 5926 consecutive patients who underwent CABG and were discharged alive. The prevalence and consistency of β-blocker use were determined in patients with and without a history of myocardial infarction (MI). β-Blockers were always used in 1280 patients (50.9%) with and 1642 patients (48.1%) without previous MI after CABG. Compared with always users (n=2922, 49.3%), the risk of all-cause death was significantly higher among inconsistent β-blocker users (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.50-2.57), and never using β-blockers was associated with increased risk of both all-cause death (HR, 1.42; 95% CI, 1.01-2.00) and the composite of adverse cardiovascular events (HR, 1.29; 95% CI, 1.10-1.50). In the cohort without MI, the HR for all-cause death was 1.70 (95% CI, 1.17-2.48) in inconsistent users and 1.23 (95% CI, 0.76-1.99) in never users. In the MI cohort, mortality was higher for inconsistent users (HR, 2.14; 95% CI, 1.43-3.20) and for never users (HR, 1.59; 95% CI, 1.07-2.63). Consistent results were obtained in equivalent sensitivity analyses.
  
  
  CONCLUSIONS
  In patients with or without previous MI undergoing CABG, the consistent use of β-blockers was associated with a lower risk of long-term mortality and adverse cardiovascular events. Strategies should be developed to understand and improve discharge prescription of β-blockers and long-term patient adherence.
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Yuan
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhang
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Sipeng
authors.initials: S
authors.lastname: Chen
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Hua
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Chenfei
authors.initials: C
authors.lastname: Rao
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Hansong
authors.initials: H
authors.lastname: Sun
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.
authors.forename: Shengshou
authors.initials: S
authors.lastname: Hu
authors.affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China. zhengzhe@fuwai.com.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zheng
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D055502:Secondary Prevention / Q000379:methods / Q000639:trends*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: adrenergic beta-antagonists; coronary artery bypass; coronary artery disease; myocardial infarction