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

Sorbets, E. et al. (2019) β-blockers, calcium antagonists, and mortality in stable coronary artery disease: an international cohort study. European Heart Journal, 40, pp. 1399-1407. (doi:10.1093/eurheartj/ehy811) (PMID:30590529) (PMCID:PMC6503455)

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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.

Item Type:Articles
Additional Information:The CLARIFY registry was supported by Servier.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Young, Dr Robin and Greenlaw, Miss Nicola and Ford, Professor Ian
Authors: Sorbets, E., Steg, P. G., Young, R., Danchin, N., Greenlaw, N., Ford, I., Tendera, M., Ferrari, R., Merkely, B., Parkhomenko, A., Reid, C., Tardif, J.-C., and Fox, K. M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN:0195-668X
ISSN (Online):1522-9645
Published Online:27 December 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in European Heart Journal 40:1399-1407
Publisher Policy:Reproduced under a Creative Commons License

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