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Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry

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Abstract

Purpose

The aim was to evaluate prognostic value of beta-blocker (BB) administration in acute coronary syndromes (ACS) patients in the percutaneous coronary intervention (PCI) era.

Methods and Results

The BleeMACS project is a multicenter, observational, retrospective registry enrolling patients with ACS worldwide in 15 hospitals. Patients discharged with BB therapy were compared to those discharged without a BB before and after propensity score with matching. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints included in-hospital reinfarction, in-hospital heart failure, 1-year myocardial infarction, 1-year bleeding and 1-year composite of death and recurrent myocardial infarction. After matching, 2935 patients for each group were enrolled. The primary endpoint of 1-year death was significantly lower in the group on BB therapy (4.5 vs 7%, p < 0.05), while only a trend was noted for recurrent acute myocardial infarction (4.5 vs 4.9%, p = 0.54). These results were consistent for patients older than 80 years of age, for ST-elevation myocardial infarction (STEMI) patients, and for those discharged with complete versus incomplete revascularization, but not for non-STEMI/unstable angina patients.

Conclusions

BB therapy was related to 1-year lower risk of all-cause mortality, independently from completeness of revascularization, admission diagnosis, age and ejection fraction. Randomized controlled trials for patients treated with PCI for ACS should be performed.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy

    Fabrizio D’Ascenzo, Dario Celentani, Alessandro Brustio, Alberto Grosso, Claudio Moretti, Maurizio D’Amico & Fiorenzo Gaita

  2. University Hospital Álvaro Cunqueiro, Vigo, Spain

    Sergio Raposeiras-Roubín, Emad Abu-Assi & José María García-Acuña

  3. University Academic Medical Center, Amsterdam, The Netherlands

    Jose Paulo Simao Henriques & Wouter J. Kikkert

  4. NorthShore University Hospital, Chicago, USA

    Jorge Saucedo

  5. University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain

    José Ramón González-Juanatey

  6. Libin Cardiovascular Institute of Alberta, Calgary, Canada

    Stephen B. Wilton & Danielle Southern

  7. San Carlos Hospital, Madrid, USA

    Iván Nuñez-Gil, Emilio Alfonso & Belén Terol

  8. Bellvitge Hospital, Barcelona, Spain

    Albert Ariza-Sole & Alberto Garay

  9. Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Xiantao Song, Dongfeng Zhang & Yalei Chen

  10. University Patras Hospital, Athens, Greece

    Dimitrios Alexopoulos & Ioanna Xanthopoulou

  11. Kerckhoff Heart and Thorax Center, Frankfurt, Germany

    Christoph Liebetrau, Neriman Osman & Helge Möllmann

  12. University Clinical Hospital, Kyoto, Japan

    Tetsuma Kawaji & Hiroki Shiomi

  13. University Clinical Hospital, Warsaw, Poland

    Zenon Huczek, Michal Kowara & Krzysztof Filipiak

  14. Institute of Heart, Lung and Blood Vessel Disease, Beijing, China

    Shao-Ping Nie, Xiao Wang, Yan Yan & Jing-Yao Fan

  15. Tokai University School of Medicine, Tokyo, Japan

    Toshiharu Fujii & Yuji Ikari

  16. Hospital Sao Rafael, Salvador, Brazil

    Luis Correia

  17. Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan

    Masa-aki Kawashiri, Takuya Nakahayshi, Kenji Sakata & Masakazu Yamagishi

  18. University Clinic of Cardiology, Skopje, Macedonia

    Oliver Kalpak & Sasko Kedev

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  1. Fabrizio D’Ascenzo
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  2. Dario Celentani
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Corresponding author

Correspondence to Fabrizio D’Ascenzo.

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No external funding was received for this study.

Conflicts of interest

Fabrizio D’Ascenzo, Dario Celentani, Alessandro Brustio, Alberto Grosso, Sergio Raposeiras-Roubín, Emad Abu-Assi, Jose Paulo Simao Henriques, Jorge Saucedo, José Ramón González-Juanatey, Stephen B. Wilton, Wouter J. Kikkert, Iván Nuñez-Gil, Albert Ariza-Sole, Xiantao Song, Dimitrios Alexopoulos, Christoph Liebetrau, Tetsuma Kawaji, Zenon Huczek, Shao-Ping Nie, Toshiharu Fujii, Luis Correia, Masa-aki Kawashiri, José María García-Acuña, Danielle Southern, Emilio Alfonso, Belén Terol, Alberto Garay, Dongfeng Zhang, Yalei Chen, Ioanna Xanthopoulou, Neriman Osman, Helge Möllmann, Hiroki Shiomi, Michal Kowara, Krzysztof Filipiak, Xiao Wang, Yan Yan, Jing-Yao Fan, Yuji Ikari, Takuya Nakahayshi, Kenji Sakata, Masakazu Yamagishi, Oliver Kalpak, Sasko Kedev, Claudio Moretti, Maurizio D’Amico, Fiorenzo Gaita declare that they have no potential conflicts of interest that might be relevant to this manuscript

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D’Ascenzo, F., Celentani, D., Brustio, A. et al. Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry. Am J Cardiovasc Drugs 18, 299–309 (2018). https://doi.org/10.1007/s40256-018-0273-4

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