“β-BLOCKER
IMPROVES PROGNOSIS IN CAD
PATIENTS”: IS THIS STILL SO WHEN THEY ARE
PART OF MODERN TREATMENT?
B angalore S , et al. β -Blocker use and c linical o utcomes in stable
outpatients with and without coronary ar tery disease. JAMA.
2012;308(13):1340-1349.
OBJECTIVES & METHODS
Background:
 T h e e v i d e n c e f o r β - b l o c k e r u s e i s d e r i v e d f r o m p o s t — my o c a r d i a l i n f a r c t i o n ( M I ) s t u d i e s a n t e d a t i n g
m o d e r n r e p e r f u s i o n o r m e d i c a l t h e r a p y, a n d h a s b e e n w i d e l y e x t r a p o l a t e d t o a l l p a t i e n t s w i t h
coronary artery disease (CAD).
 Long-term ef ficacy of β-blocker use in patients treated with contemporar y medical therapies is
not known, even in patients with prior MI.
Objectives
 The objective of the analysis of the REACH (REduction of Atherothrombosis for Continued H ealth)
r e g i s t r y w a s to a s s e s s t h e a s s o c i a t i o n o f β - b l o c k e r u s e w i t h c a r d i o v a s c u l a r e v e n t s i n p a t i e n t s w i t h
a prior MI , in those w ith CAD w ithout MI , and in those w ith CAD risk f ac tor s only.
Methods
•
The population in the REACH registr y was divided into 3 cohor ts:
 known prior MI
 known CAD without MI
 CAD risk factors only
•
P r o p e n s i t y s c o r e m a t c h i n g w a s u s e d f o r t h e a n a l y s i s , r e s u l t i n g i n 21 860 patients i n c l u d e d i n t h e
propensity score—matched analysis .
•
Median follow -up was 44 months.
•
The primary outcome w a s a c o m p o s i t e o f c a r d i o v a s c u l a r d e a t h , n o n f a t a l M I , o r n o n f a t a l s t r o k e .
•
The secondary outcome w a s t h e p r i m a r y o u t c o m e p l u s h o s p i t a l i z a t i o n o r a r e v a s c u l a r i z a t i o n .
NO PROGNOSTIC VALUE OF β-BLOCKERS IN
STABLE CORONARY PATIENTS
21 860 Patients with or without stable CAD from the REACH registry, 44 months of follow-up
Event rate for the primary outcome -- composite of cardiovascular death, nonfatal MI, or nonfatal stroke, %
HR 0.90
HR 0.92
HR 1.18
P=0.14
P=0.31
P=0.02
Stable CAD with MI
Stable CAD without MI
With risk factors only
(no CAD)
Bangalore S, et al. JAMA. 2012;308(13):1340-1349.
3
NO PROGNOSTIC VALUE OF β-BLOCKERS IN
STABLE CORONARY PATIENTS
Bangalore S, et al. JAMA. 2012;308(13):1340-1349.
IMPLICATIONS FOR CLINICAL PRACTICE
• These results showed that despite the perception that β-blockers are
beneficial in all stable CAD patients, their use in the era of modern
medical and reperfusion therapy in stable CAD patients is not associated
with lower cardiovascular event rates.
• These findings raise questions regarding the need for long-term use of βblockers in patients 1 year after MI or in those who had percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG)
without MI.