Impact of Carvedilol versus Bisoprolol on long-term clinical outcomes in STEMI patients with mid-range LVEF

초록

Background Carvedilol and Bisoprolol are widely used β-blockers with established benefits in heart failure. However, their comparative long-term outcomes in ST-segment elevation myocardial infarction (STEMI) patients with mid-range (mr) left ventricular ejection fraction (LVEF, 40% to 49%) treated with drug-eluting stents (DESs) are unclear. This study aimed to evaluate the relative effectiveness of Carvedilol and Bisoprolol in this population. Methods We analyzed data from the Korea Acute Myocardial Infarction Registry (KAMIR) involving STEMI patients with mrEF (40% to 49%) treated with DESs. Patients were grouped based on discharge prescription of Carvedilol 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 Carvedilol group (n=2,641) and the Bisoprolol group (n=2,644). At 1 year, there was a trend toward higher incidence of total death in the Carvedilol group compared to the Bisoprolol group (2.0% vs. 1.4%, HR: 1.470, 95% CI: 0.964–2.242, P=0.073), though the difference was not statistically significant. MACE incidence was similar between groups (5.4% vs. 5.0%, HR: 1.098, 95% CI: 0.860–1.400, P=0.457). Over the 3-year follow-up, the incidence of total death (4.1% vs. 4.8%, HR: 0.859, 95% CI: 0.661–1.117, P=0.286) and MACE (10.1% vs. 10.9%, HR: 0.915, 95% CI: 0.767–1.092, P=0.346) were also comparable. Conclusions In STEMI patients with mrEF treated with DESs, there was a trend toward higher incidence of total death in the Carvedilol group compared to the Bisoprolol group at 1 year but there were no significant differences in long-term outcomes between Carvedilol and Bisoprolol up to 3 years.