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Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery.

Zhang H, Yuan X, Zhang H, Chen S, Zhao Y, Hua K, Rao C, Wang W, Sun H, Hu S, Zheng Z - Circulation (2015)

Bottom Line: Compared with always users (n=2922, 49.3%), the risk of all-cause death was significantly higher among inconsistent β-blocker users (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.50-2.57), and never using β-blockers was associated with increased risk of both all-cause death (HR, 1.42; 95% CI, 1.01-2.00) and the composite of adverse cardiovascular events (HR, 1.29; 95% CI, 1.10-1.50).Consistent results were obtained in equivalent sensitivity analyses.Strategies should be developed to understand and improve discharge prescription of β-blockers and long-term patient adherence.

View Article: PubMed Central - PubMed

Affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.

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Kaplan–Meier curves of outcomes associated with β-blocker use after coronary artery bypass graft surgery. Shown are rates of all-cause death and major adverse cardiac and cerebrovascular events (MACCEs) in the overall population (A), patients without pervious myocardial infarction (MI; B), and patients with pervious MI (C). The P values were calculated with the log-rank test on the basis of all available follow-up data with always users as reference.
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Figure 1: Kaplan–Meier curves of outcomes associated with β-blocker use after coronary artery bypass graft surgery. Shown are rates of all-cause death and major adverse cardiac and cerebrovascular events (MACCEs) in the overall population (A), patients without pervious myocardial infarction (MI; B), and patients with pervious MI (C). The P values were calculated with the log-rank test on the basis of all available follow-up data with always users as reference.

Mentions: The observed long-term rates of death and the composite of MACCE were significantly higher in the inconsistent users and never users than in the always users. (Figure 1 and Table V in the online-only Data Supplement). Compared with always users, the observed frequencies of MI and stroke were similar for both the inconsistent users and never users (log-rank P=0.54 and 0.77 for MI; log-rank P=0.21 and 0.08 for stroke; Figure IV in the online-only Data Supplement). After adjustment for baseline differences with multivariable regression analysis, the risks of all-cause death and cardiac death remained consistently higher in the inconsistent users (Table 2). Never using β-blockers was associated with a higher risk of death and MACCEs, with HRs of 1.42 (95% CI, 1.01–2.00) and 1.29 (95% CI, 1.10–1.50), respectively.


Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery.

Zhang H, Yuan X, Zhang H, Chen S, Zhao Y, Hua K, Rao C, Wang W, Sun H, Hu S, Zheng Z - Circulation (2015)

Kaplan–Meier curves of outcomes associated with β-blocker use after coronary artery bypass graft surgery. Shown are rates of all-cause death and major adverse cardiac and cerebrovascular events (MACCEs) in the overall population (A), patients without pervious myocardial infarction (MI; B), and patients with pervious MI (C). The P values were calculated with the log-rank test on the basis of all available follow-up data with always users as reference.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4472324&req=5

Figure 1: Kaplan–Meier curves of outcomes associated with β-blocker use after coronary artery bypass graft surgery. Shown are rates of all-cause death and major adverse cardiac and cerebrovascular events (MACCEs) in the overall population (A), patients without pervious myocardial infarction (MI; B), and patients with pervious MI (C). The P values were calculated with the log-rank test on the basis of all available follow-up data with always users as reference.
Mentions: The observed long-term rates of death and the composite of MACCE were significantly higher in the inconsistent users and never users than in the always users. (Figure 1 and Table V in the online-only Data Supplement). Compared with always users, the observed frequencies of MI and stroke were similar for both the inconsistent users and never users (log-rank P=0.54 and 0.77 for MI; log-rank P=0.21 and 0.08 for stroke; Figure IV in the online-only Data Supplement). After adjustment for baseline differences with multivariable regression analysis, the risks of all-cause death and cardiac death remained consistently higher in the inconsistent users (Table 2). Never using β-blockers was associated with a higher risk of death and MACCEs, with HRs of 1.42 (95% CI, 1.01–2.00) and 1.29 (95% CI, 1.10–1.50), respectively.

Bottom Line: Compared with always users (n=2922, 49.3%), the risk of all-cause death was significantly higher among inconsistent β-blocker users (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.50-2.57), and never using β-blockers was associated with increased risk of both all-cause death (HR, 1.42; 95% CI, 1.01-2.00) and the composite of adverse cardiovascular events (HR, 1.29; 95% CI, 1.10-1.50).Consistent results were obtained in equivalent sensitivity analyses.Strategies should be developed to understand and improve discharge prescription of β-blockers and long-term patient adherence.

View Article: PubMed Central - PubMed

Affiliation: From National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, Haibo Zhang, Y.Z., K.H., C.R., S.H., Z.Z.); Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Heng Zhang, X.Y., K.H., C.R., W.W., H.S., S.H., Z.Z.); and School of Public Health, Capital Medical University, Beijing, China.

Show MeSH
Related in: MedlinePlus