Beta-Blockers and Outcome in Patients with Suspected Coronary Artery Disease Evaluated Noninvasively.

Abstract

Objective: Our intent was to assess the relationship between beta-blocker use and outcomes in patients with chronic coronary artery disease diagnosed using noninvasive testing but without myocardial infarction or heart failure.

Methods: Data from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) study, a prospective randomized trial comparing the effectiveness of 2 noninvasive tests in patients with a low-to-intermediate likelihood of coronary artery disease, were subjected to post hoc analysis. Patients with a history of myocardial infarction or heart failure and those with missing data on beta-blocker use at baseline were excluded. Associations between baseline beta-blocker use and the primary composite outcome (all-cause death / myocardial infarction / unstable angina hospitalization) and secondary composite outcomes (cardiovascular death / myocardial infarction / unstable angina hospitalization, and myocardial infarction / unstable angina hospitalization) over a median follow-up period of 793 days were analyzed.

Results: In total, 8,250 patients were enrolled and stratified into negative (87.5%, n = 7,215) and positive (12.5%, n = 1,035) cohorts based on noninvasive test results, of which 23.9% and 28.6% received beta-blockers, respectively. In both cohorts, patients who received beta-blockers had a similar risk of the primary composite outcome compared to those who did not receive beta-blockers (negative cohort: adjusted hazard ratio = 1.106, P = .586; positive cohort: adjusted hazard ratio = 1.077, P = .759). Similar results were observed for the secondary composite outcomes.

Conclusions: This non-randomized study showed that beta-blocker use did not affect the clinical outcomes in patients with chronic coronary artery disease diagnosed using noninvasive testing, if they had no myocardial infarction or heart failure.