Comparative clinical outcomes of nebivolol versus bisoprolol in patients with STEMI after primary PCI: a propensity-score matched analysis
J Y Park, S Rha, B G Choi, S Y Choi, B G Byun, Y J Lee, A P Baskoro, A R Partama, W Chu, S Park, E J Park, D O Kang, C U Choi, Y K Ahn, M H JeongAbstract
Background and Aims
Despite advances in primary percutaneous coronary intervention (PCI), uncertainty remains regarding the routine use of beta-blockers and potential heterogeneity among individual agents in the management of ST-segment elevation myocardial infarction (STEMI). This study aimed to investigate the clinical outcomes associated with nebivolol versus bisoprolol in patients with STEMI undergoing primary PCI.
Methods
From Korea Acute Myocardial Infarction Registry between 2011 to 2020, 5,076 patients with STEMI who underwent successful primary PCI with second-generation DES were eligible for the final analysis. The primary endpoint was all-cause death. The secondary endpoints were stroke, stent thrombosis, cardiac death, and hospitalization for heart failure (HF), and major adverse cardiac events (MACE), a composite of all-cause death, recurrent myocardial infarction (MI), and any repeat revascularization.
Results
Among the study population, 2,027 patients received nebivolol and 3,049 received bisoprolol. After 1:1 propensity score matching, 1,605 patients were included in each group. During follow-up, clinical outcomes were comparable between the nebivolol and bisoprolol groups in the propensity score-matched cohort. At 1 year, the incidence of MACE did not differ significantly between groups [HR 0.877; 95% CI 0.639–1.204; P = 0.468]. Similarly, no significant differences were observed in all-cause death (1.7% vs. 2.1%; P = 0.605) or MI (0.7% vs. 0.8%; P = 0.838). At 3 years, rates of all-cause death (3.7% in the nebivolol group and 4.3% in the bisoprolol group, HR 0.864; 95% CI 0.607–1.230; P = 0.472) and MACE (10.1% of nebivolol users and 11.0% of bisoprolol users, HR 0.905; 95% CI 0.723–1.134; P = 0.421) remained comparable between the two groups.
Conclusions
Among patients with STEMI treated with primary PCI, nebivolol and bisoprolol were associated with comparable clinical outcomes.