Impact Of 2nd-Generation Versus 3rd-Generation β-blockers On Long-Term Clinical Outcomes In ST-Segment Elevation Myocardial Infarction Patients with Diabetes Mellitus Treated with Drug-Eluting Stents

초록

BACKGROUND β-blockers are essential for managing cardiovascular disease, but the comparative long-term efficacy of 2nd-generation βblockers (2G-BB) such as Bisoprolol and 3rd-generation β-blockers (3G-BB) such as Carvedilol and Nebivolol in ST-segment elevation myocardial infarction (STEMI) patients with diabetes mellitus (DM) is unclear. This study aimed to compare the long-term outcomes of 2GBB versus 3G-BB in STEMI patients with DM treated with drug-eluting stents (DES). METHODS We analyzed data from the Korea Acute Myocardial Infarction Registry (KAMIR) involving STEMI patients with DM treated with DESs. Patients were grouped based on discharge prescription of 2G-BB or 3G-BB 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 characteristics. RESULTS After IPTW adjustment, baseline characteristics were well balanced between the 3G-BB group (n=2,357) and the 2G-BB group (n=2,258). At 1 year, the 3G-BB group had a lower incidence of MACE (6.8% vs. 10.0%, HR: 0.654, 95% CI: 0.530-0.808, P<0.001), but total death was similar (2.5% vs. 3.2%, HR: 0.781, 95% CI: 0.552-1.105, P=0.187). Over the 3-year follow-up, the incidence of MACE remained lower in the 3G-BB group (14.4% vs. 17.8%, HR: 0.777, 95% CI: 0.664-0.910, P=0.002), whereas total death (6.2% vs. 6.4%, HR: 0.968, 95% CI: 0.763-1.229, P=0.808) was similar between the two groups. CONCLUSION In STEMI patients with DM and treated with DESs, although the incidence of total deaths were similar, 3rd-generation βblockers were associated with a significantly lower risk of MACE compared to 2nd-generation β-blockers up to 3 years. These findings suggest a potential advantage for 3rd-generation β-blockers in this population.