Predictors, Trends, and Outcomes (Among Older Patients ≥65 Years of Age) Associated With Beta-Blocker Use in Patients With Stable Angina Undergoing Elective Percutaneous Coronary Intervention: Insights From the NCDR Registry

Abstract

Objectives: This study sought to examine predictors, trends, and outcomes associated with β-blocker prescriptions at discharge in patients with stable angina without prior history of myocardial infarction (MI) or systolic heart failure (HF) undergoing elective percutaneous coronary intervention (PCI).

Background: The benefits of β-blockers in patients with MI and/or systolic HF are well established. However, whether β-blockers affect outcomes in patients with stable angina, especially after PCI, remains uncertain.

Methods: We included patients with stable angina without prior history of MI, left ventricular systolic dysfunction (left ventricular ejection fraction <40%) or systolic HF undergoing elective PCI between January 2005 and March 2013 from the hospitals enrolled in the National Cardiovascular Data Registry (NCDR) CathPCI registry. These patients were retrospectively analyzed for predictors and trends of β-blocker prescriptions at discharge. All-cause mortality (primary endpoint), revascularization, or hospitalization related to MI, HF, or stroke at 30-day and 3-year follow-up were analyzed among patients ≥65 years of age.

Results: A total of 755,215 patients from 1,443 sites were studied, and 71.4% population of our cohort was discharged on β-blockers. At 3-year follow-up among patients ≥65 years of age with CMS data linkage (16.3% of the studied population), there was no difference in adjusted mortality rate (14.0% vs. 13.3%; adjusted hazard ratio [HR]: 1.00; 95% confidence interval [CI]: 0.96 to 1.03; p = 0.84), MI (4.2% vs. 3.9%; adjusted HR: 1.00; 95% CI: 0.93 to 1.07; p = 0.92), stroke (2.3% vs. 2.0%; adjusted HR: 1.08; 95% CI: 0.98 to 1.18; p = 0.14) or revascularization (18.2% vs. 17.8%; adjusted HR: 0.97; 95% CI: 0.94 to 1.01; p = 0.10) with β-blocker prescription. However, discharge on β-blockers was associated with more HF readmissions at 3-year follow-up (8.0% vs. 6.1%; adjusted HR: 1.18; 95% CI: 1.12 to 1.25; p < 0.001). Results at 30-day follow-up were broadly consistent as well. During the period between 2005 and 2013, there was a gradual increase in prescription of β-blockers at the index discharge in our cohort (p < 0.001).

Conclusions: Among patients ≥65 years of age with history of stable angina without prior MI, systolic HF or left ventricular ejection fraction <40% undergoing elective PCI, β-blocker use at discharge was not associated with any reduction in cardiovascular morbidity or mortality at 30-day and at 3-year follow-up. Over time, β-blockers use at discharge in this population has continued to increase.

Keywords: percutaneous coronary intervention; stable angina; β-blockers.