β-blocker adherence trajectories and 5-year clinical outcomes in PCI-treated ACS patients with LVEF ≥50%: a group-based trajectory modeling analysis
Y Han, C Yan, H Song, Y Li, M Qiu, K Na, S ZhangAbstract
Background
β-blockers are a core medication for the secondary prevention of acute coronary syndrome (ACS). However, their long-term benefits in ACS patients with left ventricular ejection fraction (LVEF) ≥50% remain controversial. Previous studies have mostly focused on static medication status, lacking analyses of dynamic medication adherence trajectories and heterogeneity across ACS subtypes.
Purpose
This study aimed to identify and classify trajectory patterns of β-blocker use after discharge using Group-Based Trajectory Modeling (GBTM) in ACS patients who underwent percutaneous coronary intervention (PCI) with LVEF ≥50%, to investigate the association between different adherence trajectory groups and 5-year clinical outcomes, and to clarify potential heterogeneity of this association across different clinical subtypes.
Methods
We enrolled patients who were prescribed β-blockers at discharge and had no adverse events within 1 year after discharge. GBTM was used to characterize β-blocker adherence trajectories during the first year after PCI, and the correlation between different trajectory groups and clinical outcomes was further evaluated. Stratified analyses were performed according to ACS type to explore subtype-specific differences in this correlation. The primary endpoint was defined as major adverse cardiac and cerebrovascular events (MACCE) within 5 years after PCI, a composite endpoint consisting of all-cause death, myocardial infarction (MI), stroke, and any revascularization. Secondary endpoints were the individual components of the primary endpoint.
Results
A total of 3552 patients on β-blocker therapy with no adverse events (death, MI, stroke, revascularization, rehospitalization) within 1 year were included. Based on 1-year post-discharge β-blocker adherence trajectories, patients were divided into three groups: consistent adherence (n=1645), fluctuating adherence (n=965), and rapid discontinuation (n=942). The incidence of MACCE was significantly lower in the consistent adherence group (10.6% vs 13.5% vs 14.4%, P=0.010). However, multivariate Cox regression showed no significant difference in 5-year MACCE risk between the other two groups and the consistent adherence group. Subgroup analysis by ACS type demonstrated that in the AMI subgroup, rapid discontinuation was associated with a significantly higher MACCE risk (adjusted HR: 1.747, 95%CI: 1.212–2.518, P=0.003), whereas no significant difference was observed in the unstable angina subgroup.
Conclusions
In ACS patients with LVEF ≥50%, the long-term impact of β-blockers on clinical outcomes depends on medication adherence and disease subtype. Among AMI patients, good post-discharge β-blocker adherence significantly reduces the risk of adverse cardiovascular events. Thus, β-blocker use should be individually evaluated in these ACS patients, and enhanced adherence management in AMI patients may improve long-term prognosis.