β-blockers, calcium antagonists, and mortality in stable coronary artery disease: an international cohort study.

Emmanuel Sorbets, Philippe Gabriel Steg, Robin Young, Nicolas Danchin, Nicola Greenlaw, Ian Ford, Michal Tendera, Roberto Ferrari, Bela Merkely, Alexander Parkhomenko, Christopher Reid, Jean-Claude Tardif, Kim M Fox

REVIEW


19 March 2019

This study raises important questions about the use of beta-blockers in stable coronary artery disease. However, as the authors acknowledge, there were substantial differences between patients using beta-blockers and calcium channel antagonists, so the jury is out as to whether this is a reliable finding. 


RELEVANCE 2
INNOVATIVENESS 3
APPLICABILITY 1
OVERALL 2

PAPER DETAILS


TITLE

β-blockers, calcium antagonists, and mortality in stable coronary artery disease: an international cohort study.

ABSTRACT

Aims
The effect of first-line antianginal agents, β-blockers, and calcium antagonists on clinical outcomes in stable coronary artery disease (CAD) remains uncertain.

Methods and results
We analysed the use of β-blockers or calcium antagonists (baseline and annually) and outcomes in 22 006 stable CAD patients (enrolled 2009-2010) followed annually to 5 years, in the CLARIFY registry (45 countries). Primary outcome was all-cause death. Secondary outcomes were cardiovascular death and the composite of cardiovascular death/non-fatal myocardial infarction (MI). After multivariable adjustment, baseline β-blocker use was not associated with lower all-cause death [1345 (7.8%) in users vs. 407 (8.4%) in non-users; hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.84-1.06; P = 0.30]; cardiovascular death [861 (5.0%) vs. 262 (5.4%); HR 0.91, 95% CI 0.79-1.05; P = 0.20]; or cardiovascular death/non-fatal MI [1272 (7.4%) vs. 340 (7.0%); HR 1.03, 95% CI 0.91-1.16; P = 0.66]. Sensitivity analyses according to β-blocker use over time and to prescribed dose produced similar results. Among prior MI patients, for those enrolled in the year following MI, baseline β-blocker use was associated with lower all-cause death [205 (7.0%) vs. 59 (10.3%); HR 0.68, 95% CI 0.50-0.91; P = 0.01]; cardiovascular death [132 (4.5%) vs. 49 (8.5%); HR 0.52, 95% CI 0.37-0.73; P = 0.0001]; and cardiovascular death/non-fatal MI [212 (7.2%) vs. 59 (10.3%); HR 0.69, 95% CI 0.52-0.93; P = 0.01]. Calcium antagonists were not associated with any difference in mortality.

Conclusion
In this contemporary cohort of stable CAD, β-blocker use was associated with lower 5-year mortality only in patients enrolled in the year following MI. Use of calcium antagonists was not associated with superior mortality, regardless of history of MI.



AUTHOR(S)

Emmanuel Sorbets, Philippe Gabriel Steg, Robin Young, Nicolas Danchin, Nicola Greenlaw, Ian Ford, Michal Tendera, Roberto Ferrari, Bela Merkely, Alexander Parkhomenko, Christopher Reid, Jean-Claude Tardif, Kim M Fox,

JOURNAL

European heart journal

PLACE

England