CLINICAL OUTCOMES OF NEBIVOLOL VERSUS CARVEDILOL IN STEMI PATIENTS AFTER SUCCESSFUL PCI WITH DRUG-ELUTING STENTS: KAMIR REGISTRY INSIGHTS

초록

Objective: The selection of the optimal beta-blocker following ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) and drug-eluting stents (DES) remains unclear. This study aimed to compare the long-term clinical outcomes of newer-generation nebivolol and conventional carvedilol in real-world Korean STEMI survivors. Design and method: This retrospective study used data from the Korea Acute Myocardial Infarction Registry (KAMIR), including KAMIR–National Institutes of Health (NIH) and KAMIR-V cohorts (2011–2020). STEMI patients who survived hospitalization, underwent successful PCI with second-generation DES, and were discharged on either nebivolol or carvedilol were analyzed. The primary endpoint was 3-year all-cause death, while secondary endpoints included major adverse cardiac events (MACE), myocardial infarction (MI), revascularization, and heart failure rehospitalization. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. Results: Among 9,200 eligible STEMI patients (2,027 on nebivolol and 4,725 on carvedilol), baseline differences were effectively minimized after IPTW adjustment (6,642 vs. 6,749 patients). Over a median follow-up of 3 years, nebivolol was associated with higher all-cause mortality (4.4% vs. 3.4%; hazard ratio [HR], 1.315; 95% confidence interval [CI], 1.102–1.569; P = 0.002) and MACE (11.1% vs. 9.6%; HR, 1.176; 95% CI, 1.052–1.314; P = 0.005). No significant differences were observed in cardiac death, MI, or heart failure rehospitalization. Subgroup analysis showed consistent trends favoring carvedilol, especially in elderly and diabetic patients. Conclusions: In this large nationwide PCI-treated STEMI cohort, nebivolol did not demonstrate noninferiority to carvedilol regarding long-term mortality or MACE. Carvedilol remains the preferred beta-blocker for secondary prevention after STEMI, while further randomized trials are warranted to confirm these findings in the contemporary revascularization era.