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

초록

Background Carvedilol and Bisoprolol are widely used β-blockers for cardiovascular disease management, but their comparative effectiveness in ST-segment elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF ≥50%) and treated with drug-eluting stents (DESs) implantation is not well established. This study aimed to compare the long-term outcomes of these two different β-blockers. Methods We analyzed data from the Korea Acute Myocardial Infarction Registry (KAMIR) involving STEMI patients with preserved LVEF 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, and 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=4,045) and the Bisoprolol group (n=3,998). At 1 year, the incidence of total death (0.9% vs. 1.0%, HR: 0.890, 95% CI: 0.570–1.392, P=0.650) and MACE (4.3% vs. 4.7%, HR: 0.895, 95% CI: 0.724–1.105, P=0.307) were similar between the two groups. Over the 3-year follow-up, the incidence of total death (3.1% vs. 2.5%, HR: 1.240, 95% CI: 0.951–1.618, P=0.121) and MACE incidence (9.5% vs. 9.6%, HR: 0.990, 95% CI: 0.852–1.149, P=0.909) remained comparable. Conclusions In STEMI patients with preserved LVEF treated with DESs, there were no significant differences in long-term clinical outcomes between Carvedilol and Bisoprolol.