Bangalore S, et al. β-Blocker use and clinical outcomes in stable

outpatients with and without coronary artery disease. JAMA.

2012;308(13):1340-1349.

?“β-BLOCKER IMPROVES PROGNOSIS IN CAD PATIENTS”: IS THIS STILL SO WHEN THEY ARE PART OF MODERN TREATMENT?

Background: The evidence for β-blocker use is derived from post—myocardial infarction (MI) studies antedating modern

reperfusion or medical therapy, and has been widely extrapolated to all patients with coronary artery disease (CAD).

Long-term efficacy of β-blocker use in patients treated with contemporary 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 Health) registry was to

assess the association of β-blocker use with cardiovascular events in patients with a prior MI, in those with CAD without MI, and in those with CAD risk factors only.

Methods• The population in the REACH registry was divided into 3 cohorts:

known prior MI known CAD without MI CAD risk factors only

• Propensity score matching was used for the analysis, resulting in 21 860 patients included in the propensity score—matched analysis .

• Median follow-up was 44 months. • The primary outcome was a composite of cardiovascular death, nonfatal MI, or nonfatal stroke. • The secondary outcome was the primary outcome plus hospitalization or a revascularization.

OBJECTIVES & METHODS

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

Bangalore S, et al. JAMA. 2012;308(13):1340-1349.

3

Stable CAD with

MI

Stable CAD without

MI

HR 0.90

P=0.14

HR 0.92

P=0.31

HR 1.18

P=0.02

Event rate for the primary outcome -- composite of cardiovascular death, nonfatal MI, or nonfatal stroke,

%

With risk factors only

(no CAD)

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 β-

blockers in patients 1 year after MI or in those who had percutaneous

coronary intervention (PCI) or coronary artery bypass grafting (CABG)

without MI.