Impact of beta-blocker nebivolol versus carvedilol prescription at discharge on long-term clinical outcomes in STEMI patients with reduced LVEF treated with drug-eluting stents

초록

Background Nebivolol and Carvedilol, both third-generation β-blockers, offer distinct mechanisms of action and potential benefits in patients with cardiovascular disease. However, their comparative long-term outcomes in ST-segment elevation myocardial infarction (STEMI) patients with reduced left ventricular ejection fraction (LVEF <40%) treated with drug-eluting stents (DESs) are not well studied. Methods We analyzed data from the Korea Acute Myocardial Infarction Registry (KAMIR) involving STEMI patients with reduced LVEF treated with DESs. Patients were grouped based on Nebivolol or Carvedilol prescription at discharge 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 baseline confounders. Results After IPTW adjustment, baseline characteristics were well balanced between the Nebivolol group (n=895) and the Carvedilol group (n=930). At 1 year, there was no significant difference in the incidence of total death (4.5% vs. 3.5%, HR: 1.271, 95% CI: 0.794–2.035, P=0.340) and MACE (6.9% vs. 8.5%, HR: 0.800, 95% CI: 0.566–1.131, P=0.220) between the two groups. Over the 3-year follow-up, the incidence of total death (6.7% vs. 6.5%, HR: 1.041, 95% CI: 0.719–1.508, P=0.851) and MACE (12.4% vs. 13.4%, HR: 0.911, 95% CI: 0.693–1.199, P=0.530) remained comparable between the groups. Conclusions In STEMI patients with reduced LVEF treated with DESs, discharge prescriptions of Nebivolol and Carvedilol resulted in similar long-term outcomes for all-cause death and MACE after IPTW adjustment. These findings suggest that both Nebivolol and Carvedilol are equally safe and effective options for long-term management in this population.