β‑blockers after percutaneous coronary intervention does not reduce risks of all-cause mortality or major adverse cardiovascular events in patients with stable coronary artery disease

doi:10.12122/j.issn.1673-4254.2026.01.17

Abstract

Abstract:

Objective To explore the association between the use of β-blockers and the risks of all-cause mortality and major adverse cardiovascular events (MACEs) in patients with stable coronary artery disease (SCAD) after percutaneous coronary intervention (PCI). Methods We performed secondary analyses of the data of 55 SCAD patients receiving post-PCI β-blocker treatment and 149 patients without post-PCI β‑blockers (control group) from the Dryad database. The clinical and coronary artery disease characteristics of the patients were analyzed, and propensity score matching was used to compare all-cause mortality and MACEs (including cardiovascular death, non-fatal myocardial infarction and non-fatal stroke) between the two groups. Results The overall patients (69.6% were male) had a mean age of 72.6±10.3 years with a median follow-up time of 783 days. A total of 18 patients (8.8%) died, and MACEs occurred in 19 patients (9.3%), including cardiovascular death in 6 cases (2.9%), non-fatal myocardial infarction in 3 cases (1.5%) and non-fatal stroke in 11 cases (5.4%). In the β‑blocker group, deaths occurred in 5 cases (9.1%), and MACEs in 4 cases (7.3%), including 2 cases with cardiovascular death (3.6%) and 2 cases with non-fatal stroke (3.6%). Kaplan-Meier survival curve analysis showed that the use of β-blockers after PCI was not associated with a reduced all-cause mortality (8.7% vs 9.1%, log-rank P=0.870) or incidence of MACEs (10.1% vs 7.3%, log-rank P=0.510) either before or after adjusting for age, sex, aspartate aminotransferase, estimated glomerular filtration rate, left ventricular ejection fraction, and history of atrial fibrillation (HR=0.81, 95% CI: 0.24-2.72; HR=0.62, 95% CI: 0.22-1.69). No significant differences were found in all-cause death or MACEs between the two groups after propensity score adjustment, matching, or IPTW inverse probability weighting (all P>0.05). Conclusion Routine use of β-blockers after PCI does not reduce the incidence of all-cause death or MACEs in patients with SCAD.

Key words: stable coronary artery disease, percutaneous coronary intervention, β-blockers, all-cause mortality, major adverse cardiovascular events

Xiyu GAO, Jing XIAO, Na FENG, Chen GUO, Lifei CAO, Chunyan ZHANG, Yan ZHANG, Tuo HAN. β‑blockers after percutaneous coronary intervention does not reduce risks of all-cause mortality or major adverse cardiovascular events in patients with stable coronary artery disease[J]. Journal of Southern Medical University, 2026, 46(1): 159-165.

Figures/Tables 4

References 31

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Variable	Total (n=204)	Control group (n=149)	β-blocker group (n=55)	Statistic	P
Age (year)	72.6±10.3	72.9±10.1	71.8±11.0	0.416	0.520
Gender [n (%)]				0.060	0.806
Female	62 (30.4)	46 (30.9)	16 (29.1)
Male	142 (69.6)	103 (69.1)	39 (70.9)
Smoking [n (%)]	101 (49.5)	77 (51.7)	24 (43.6)	1.039	0.308
BMI (kg/m²)	23.6±3.9	23.4±3.8	24.3±4.1	2.018	0.157
SBP (mmHg)	136.3±20.4	135.8±19.6	137.5±22.7	0.254	0.615
DBP (mmHg)	77.4±13.2	77.2±12.9	77.9±14.1	0.108	0.743
Hemoglobin (g/dL)	13.6±2.0	13.6±1.9	13.5±2.2	0.037	0.847
Albumin (g/L)	3.9±0.5	3.9±0.5	3.9±0.5	0.167	0.683
eGFR (mL/min/1.73 m²)	61.3±24.6	63.8±24.2	54.7±24.6	5.583	0.019
AST (U/L)	24.7±11.0	25.5±11.6	22.6±8.7	2.841	0.093
ALT (U/L)	20.9±12.2	21.5±12.7	19.5±10.6	1.016	0.315
TC (mg/dL)	185.4±35.7	184.4±35.2	188.4±37.4	0.390	0.533
TG (mg/dL)	117.0 (83.5, 159.5)	118.0 (84.0, 157.0)	105.5 (73.5, 159.8)	1.052	0.305
HDL-C (mg/dL)	50.2±13.2	49.9±13.0	51.1±13.8	0.314	0.576
LDL-C (mg/dL)	110.1±28.5	109.3±28.3	112.1±29.4	0.394	0.531
HbA1C (%)	6.0 (5.7, 6.7)	6.0 (5.6, 6.6)	6.0 (5.7, 7.0)	2.139	0.144
CRP (mg/dL)	0.1 (0.0, 0.3)	0.1 (0.0, 0.3)	0.1 (0.1, 0.3)	1.240	0.266
LVEF (%)	63.2±9.8	65.0±7.3	58.6±13.6	18.205	<0.001
Cerebral infarction [n (%)]	35 (17.2)	27 (18.1)	8 (14.5)	0.361	0.548
Peripheral arterial disease [n (%)]	53 (26.0)	42 (28.2)	11 (20)	1.400	0.237
Atrial fibrillation [n (%)]	26 (12.7)	13 (8.7)	13 (23.6)	8.032	0.005
Hypertension [n (%)]	151 (74.0)	111 (74.5)	40 (72.7)	0.065	0.798
Dyslipidemia [n (%)]	104 (51.0)	78 (52.3)	26 (47.3)	0.414	0.520
Diabetes [n (%)]	73 (35.8)	50 (33.6)	23 (41.8)	1.193	0.275

Variable	Total (n=204)	Control group (n=149)	β-blocker group (n=55)	Statistic	P
Age (year)	72.6±10.3	72.9±10.1	71.8±11.0	0.416	0.520
Gender [n (%)]				0.060	0.806
Female	62 (30.4)	46 (30.9)	16 (29.1)
Male	142 (69.6)	103 (69.1)	39 (70.9)
Smoking [n (%)]	101 (49.5)	77 (51.7)	24 (43.6)	1.039	0.308
BMI (kg/m²)	23.6±3.9	23.4±3.8	24.3±4.1	2.018	0.157
SBP (mmHg)	136.3±20.4	135.8±19.6	137.5±22.7	0.254	0.615
DBP (mmHg)	77.4±13.2	77.2±12.9	77.9±14.1	0.108	0.743
Hemoglobin (g/dL)	13.6±2.0	13.6±1.9	13.5±2.2	0.037	0.847
Albumin (g/L)	3.9±0.5	3.9±0.5	3.9±0.5	0.167	0.683
eGFR (mL/min/1.73 m²)	61.3±24.6	63.8±24.2	54.7±24.6	5.583	0.019
AST (U/L)	24.7±11.0	25.5±11.6	22.6±8.7	2.841	0.093
ALT (U/L)	20.9±12.2	21.5±12.7	19.5±10.6	1.016	0.315
TC (mg/dL)	185.4±35.7	184.4±35.2	188.4±37.4	0.390	0.533
TG (mg/dL)	117.0 (83.5, 159.5)	118.0 (84.0, 157.0)	105.5 (73.5, 159.8)	1.052	0.305
HDL-C (mg/dL)	50.2±13.2	49.9±13.0	51.1±13.8	0.314	0.576
LDL-C (mg/dL)	110.1±28.5	109.3±28.3	112.1±29.4	0.394	0.531
HbA1C (%)	6.0 (5.7, 6.7)	6.0 (5.6, 6.6)	6.0 (5.7, 7.0)	2.139	0.144
CRP (mg/dL)	0.1 (0.0, 0.3)	0.1 (0.0, 0.3)	0.1 (0.1, 0.3)	1.240	0.266
LVEF (%)	63.2±9.8	65.0±7.3	58.6±13.6	18.205	<0.001
Cerebral infarction [n (%)]	35 (17.2)	27 (18.1)	8 (14.5)	0.361	0.548
Peripheral arterial disease [n (%)]	53 (26.0)	42 (28.2)	11 (20)	1.400	0.237
Atrial fibrillation [n (%)]	26 (12.7)	13 (8.7)	13 (23.6)	8.032	0.005
Hypertension [n (%)]	151 (74.0)	111 (74.5)	40 (72.7)	0.065	0.798
Dyslipidemia [n (%)]	104 (51.0)	78 (52.3)	26 (47.3)	0.414	0.520
Diabetes [n (%)]	73 (35.8)	50 (33.6)	23 (41.8)	1.193	0.275

Variable	Total (n=204)	Control group (n=149)	β-blocker group (n=55)	Statistic	P
Coronary angiography status
LMT lesions	13 (6.4)	10 (6.7)	3 (5.5)	-	1.000
Bifurcation lesions	102 (50.0)	70 (47)	32 (58.2)	2.016	0.156
Ostial lesions	30 (14.7)	22 (14.8)	8 (14.5)	0.002	0.969
Calcified lesions	29 (14.2)	21 (14.1)	8 (14.5)	0.007	0.935
CTO lesions	12 (5.9)	9 (6)	3 (5.5)	-	1.000
Multi-vessel lesions	53 (26.0)	38 (25.5)	15 (27.3)	0.065	0.798
Stent				-	0.171
BMS	11 (5.4)	6 (4)	5 (9.1)
DES	193 (94.6)	143 (96)	50 (90.9)
Medication
Aspirin	202 (99.0)	148 (99.3)	54 (98.2)	-	0.467
Thienopiridines	200 (98.0)	147 (98.7)	53 (96.4)	-	0.294
Warfarin	5 (2.5)	2 (1.3)	3 (5.5)	-	0.123
NOAC	21 (10.3)	12 (8.1)	9 (16.4)	3.004	0.083
Ezetimibe	3 (1.5)	3 (2)	0 (0)	-	0.565
PPI	134 (65.7)	104 (69.8)	30 (54.5)	4.147	0.042
Statin	111 (54.4)	86 (57.7)	25 (45.5)	2.436	0.119
ACEI	19 (9.3)	14 (9.4)	5 (9.1)	0.004	0.947
ARB	88 (43.1)	66 (44.3)	22 (40)	0.302	0.583
MRA	11 (5.4)	5 (3.4)	6 (10.9)	-	0.072
Outcomes
All-cause death	18 (8.8)	13 (8.7)	5 (9.1)	-	1.000
MACEs	19 (9.3)	15 (10.1)	4 (7.3)	0.371	0.542
Cardiovascular death	6 (2.9)	4 (2.7)	2 (3.6)	-	0.662
Non-fatal MI	3 (1.5)	3 (2.0)	0 (0.0)	-	0.565
Non-fatal stroke	11 (5.4)	9 (6.0)	2 (3.6)	-	0.731

Variable	Total (n=204)	Control group (n=149)	β-blocker group (n=55)	Statistic	P
Coronary angiography status
LMT lesions	13 (6.4)	10 (6.7)	3 (5.5)	-	1.000
Bifurcation lesions	102 (50.0)	70 (47)	32 (58.2)	2.016	0.156
Ostial lesions	30 (14.7)	22 (14.8)	8 (14.5)	0.002	0.969
Calcified lesions	29 (14.2)	21 (14.1)	8 (14.5)	0.007	0.935
CTO lesions	12 (5.9)	9 (6)	3 (5.5)	-	1.000
Multi-vessel lesions	53 (26.0)	38 (25.5)	15 (27.3)	0.065	0.798
Stent				-	0.171
BMS	11 (5.4)	6 (4)	5 (9.1)
DES	193 (94.6)	143 (96)	50 (90.9)
Medication
Aspirin	202 (99.0)	148 (99.3)	54 (98.2)	-	0.467
Thienopiridines	200 (98.0)	147 (98.7)	53 (96.4)	-	0.294
Warfarin	5 (2.5)	2 (1.3)	3 (5.5)	-	0.123
NOAC	21 (10.3)	12 (8.1)	9 (16.4)	3.004	0.083
Ezetimibe	3 (1.5)	3 (2)	0 (0)	-	0.565
PPI	134 (65.7)	104 (69.8)	30 (54.5)	4.147	0.042
Statin	111 (54.4)	86 (57.7)	25 (45.5)	2.436	0.119
ACEI	19 (9.3)	14 (9.4)	5 (9.1)	0.004	0.947
ARB	88 (43.1)	66 (44.3)	22 (40)	0.302	0.583
MRA	11 (5.4)	5 (3.4)	6 (10.9)	-	0.072
Outcomes
All-cause death	18 (8.8)	13 (8.7)	5 (9.1)	-	1.000
MACEs	19 (9.3)	15 (10.1)	4 (7.3)	0.371	0.542
Cardiovascular death	6 (2.9)	4 (2.7)	2 (3.6)	-	0.662
Non-fatal MI	3 (1.5)	3 (2.0)	0 (0.0)	-	0.565
Non-fatal stroke	11 (5.4)	9 (6.0)	2 (3.6)	-	0.731

Model	All-cause death		MACEs
Model	HR (95% CI)	P	HR (95% CI)	P
Univariate Cox regression	1.08 (0.38-3.04)	0.881	0.73 (0.30-1.81)	0.498
Multivariate Cox regression*	0.81 (0.24-2.72)	0.735	0.62 (0.22-1.69)	0.348
PS adjustment	0.69 (0.21-2.27)	0.542	0.56 (0.20-1.52)	0.255
PS matching	1.49 (0.25-8.91)	0.664	0.59 (0.17-2.10)	0.415
IPTW	0.60 (0.17-2.11)	0.383	0.53 (0.20-1.45)	0.244
SMRW	0.91 (0.33-2.54)	0.881	0.64 (0.26-1.58)	0.386