Impact Of Nebivolol Versus Bisoprolol on Long-term Outcomes On Long-Term Clinical Outcomes In ST-elevation Myocardial Infarction Patients With Mid-range Left Ventricular Ejection Fraction (40% To 49%)

초록

BACKGROUND Nebivolol and Bisoprolol are commonly prescribed βblockers with different pharmacological properties. While Bisoprolol is a selective β1-blocker, Nebivolol offers additional vasodilatory effects through nitric oxide modulation. However, their comparative long-term outcomes in ST-segment elevation myocardial infarction (STEMI) patients with mid-range (mr) reduced left ventricular ejection fraction (LVEF, 40% to 49%) treated with drug-eluting stents (DESs) are not well established. METHODS We analyzed data from the Korea Acute Myocardial Infarction Registry (KAMIR) involving STEMI patients with mrEF treated with DESs. Patients were grouped based on discharge prescription of Nebivolol or Bisoprolol and followed for up to 3 years. The primary endpoint was all-cause death, while the secondary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction (MI), and revascularization. Inverse probability of treatment weighting (IPTW) was used to adjust for confounders. RESULTS After IPTW adjustment, baseline characteristics were well balanced between the Nebivolol group (n=1,458) and the Bisoprolol group (n=1,613). At 1 year, the incidence of total death was significantly lower in the Nebivolol group compared to the Bisoprolol group (0.8% vs. 1.7%, HR: 0.469, 95% CI: 0.237-0.927, P=0.026). The incidence of MACE was also significantly lower in the Nebivolol group (3.2% vs. 5.3%, HR: 0.585, 95% CI: 0.406-0.844, P=0.004). Over 3 years, the incidence of total death (2.8% vs. 4.3%, HR: 0.647, 95% CI: 0.436-0.959, P=0.032) remained significantly lower in the Nebivolol group, while MACE incidence was comparable between the two groups (10.1% vs. 10.6%, HR: 0.946, 95% CI: 0.749-1.194, P=0.678). CONCLUSION In STEMI patients with mrEF and treated with DESs, discharge prescription of Nebivolol was associated with a significantly lower risk of total death at 1 and 3 years compared to Bisoprolol. While MACE incidence was similar at 3 years, these findings suggest that Nebivolol may offer early survival benefits in this patient population