4054Betablockers and outcomes in stable coronary artery disease. Insights from the CLARIFY registry

Abstract

Background: The role of beta blockers (BB) in the management of stable coronary artery disease (CAD) remains disputed. Data suggesting benefit are largely derived from post myocardial infarction trials antedating the advent of revascularization. Recent studies suggest that BB may have limited benefit in stable CAD patients without heart failure (HF). Purpose(s): To describe the use of BB and their association with outcomes in a large contemporary cohort of stable CAD patients. Method(s): CLARIFY is an observational longitudinal cohort of stable CAD patients from 45 countries enrolled in 2009-2010. The inclusion criteria were any of the following (non-mutually exclusive): prior myocardial infarction (MI); angiographic coronary stenosis >50%; proven symptomatic myocardial ischemia; or prior revascularization procedure. The main exclusion criteria were severe diseases including advanced HF or conditions interfering with life expectancy. Follow-up was by yearly visits up to 5 years. Comparisons were done with multivariable adjusted Cox proportional hazards models. Result(s): At baseline among 32 376 patients, 24 372 (75.3%) were treated by BB. The most prevalent BB were bisoprolol (34.3%), metoprolol (28.0%), atenolol (14.8%), carvedilol (11.6%) and nebivolol (5.7%). Patients with BB, compared to those without, were younger, with more symptoms of angina or HF, diabetes, hypertension, hypercholesterolemia and prior MI, coronary revascularization or hospitalization for HF. At 5 years, after adjustment with a multivariable model (including the CV REACH risk score, blood pressure, left ventricular ejection fraction and histories of revascularisation, peripheral artery disease and asthma/chronicle obstructive pulmonary disease), BB use at baseline was not associated with any difference in the occurrence of major events, including all-cause death, CV death, non-CV death, CV death or non-fatal MI or non-fatal stroke (Table). Results were consistent when accounting for changes in use of BB over time. A sensitivity analysis excluding patients with intolerance or contraindication to BB, focused on attainment of target recommended doses of BB found similar results. (Table presented) Conclusion(s): In this large contemporary cohort of stable CAD without chronic HF, BB use whatever the dose was not associated with difference in major outcomes.