New York—Treatment with beta-blockers after angioplasty appears to have minimal effect for patients with stable angina and no history of heart attack or heart failure.
That’s according to a study published by JACC: Cardiovascular Interventions, finding that, after the procedure, beta-blockers did not significantly improve mortality rates or reduce the number of future cardiovascular incidents for older patients with stable angina but no history of heart attack or heart failure.
For the study, led by researchers from New York-Presbyterian Hospital/Columbia University, data from the NCDR CathPCI Registry was linked with Medicare information. The study team examined records from 755,215 patients from 1,443 sites between January 2005 and March 2013, 71.4% of whom received a prescription for beta-blockers. Participants on beta-blockers were likely to be younger, female, and more likely to have a history of hypertension, diabetes, high cholesterol, smoking, dialysis, and prior angioplasty.
Results indicate that after adjustment for age, gender, body mass index, smoking status, hypertension, and other variables, no significant differences in outcomes had occurred at 30 days. In fact, mortality rates and the occurrence of cardiac events were under 1.0% in both groups.
At the 3-year mark, the following outcomes occurred in patients prescribed beta-blockers compared to those who had not been:
• Mortality rate: 14% versus 13.3%;
• Incidence of heart attack: 4.2% versus 3.9%;
• Occurrence of stroke: 2.3% versus 2%;
• Occurrence of a revascularization procedure: 18% versus 17.8%, and
• Hospital readmission: 8.0% versus 6.1%.
Yet, over the 8-year study, researchers also note that the use of beta-blockers increased for patients with angioplasty.
Lead author Apurva A. Motivala, MD, FACC, FSCAI, an interventional cardiologist affiliated with New York-Presbyterian Hospital/Columbia University, suggested that because patients in the intervention group had a higher prevalence of traditional risk factors that lead to adverse cardiac events, they might have done even less well without beta-blockers. Motivala said, however, that increased incidence of hospital readmissions due to heart failure in that group is a mystery and requires further study.
In an accompanying editorial, Anthony G. Nappi, MD, a cardiologist at Albany Stratton Veterans Affairs (VA) Medical Center, and William F. Boden, MD, FACC, professor of medicine at Albany Medical College and chief of medicine at Albany Stratton VA Medical Center, posited that the increased frequency in beta-blocker prescriptions over time “is perhaps not surprising.”
“This study, along with others, raises questions about the continued role of beta-blockers in patients with coronary artery disease undergoing angioplasty, especially since there is no evidence of clinical benefit in patients without prior heart attack or heart failure,” Nappi and Boden write.
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