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β-blocker Therapy is Not Associated with Reductions in Angina or Cardiovascular Events After Coronary Artery Bypass Graft Surgery: Insights from the IMAGINE Trial.

Booij HG, Damman K, Warnica JW, Rouleau JL, van Gilst WH, Westenbrink BD - Cardiovasc Drugs Ther (2015)

Bottom Line: During a median follow-up of 33 months, β-blocker therapy was not associated with a reduction in cardiovascular events (hazard ratio 0.97; 95 % confidence interval 0.74-1.27), documented angina (hazard ratio 0.85; 95 % confidence interval 0.61-1.19) or any of the individual components of the combined endpoint.There were no relevant interactions for demographics, comorbidities or surgical characteristics.Propensity matched and time-dependent analyses revealed similar results. β-blocker therapy after CABG is not associated with reductions in angina or cardiovascular events in low-risk patients with preserved LVEF, and may not be systematically indicated in such patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, P O Box 30001, 9700 RB, Groningen, The Netherlands, hg.booij@umcg.nl.

ABSTRACT

Purpose: To evaluate whether β-blockers were associated with a reduction in cardiovascular events or angina after Coronary Artery Bypass Graft (CABG) surgery, in otherwise stable low-risk patients during a mid-term follow-up.

Methods: We performed a post-hoc analysis of the IMAGINE (Ischemia Management with Accupril post-bypass Graft via Inhibition of angiotensin coNverting Enzyme) trial, which tested the effect of Quinapril in 2553 hemodynamically stable patients with left ventricular ejection fraction (LVEF) >40 %, after scheduled CABG. The association between β-blocker therapy and the incidence of cardiovascular events (death, cardiac arrest, myocardial infarction, revascularizations, angina requiring hospitalization, stroke or hospitalization for heart failure) or angina that was documented to be due to underlying ischemia was tested with Cox regression and propensity adjusted analyses.

Results: In total, 1709 patients (76.5 %) were using a β-blocker. Patients had excellent control of risk factors; with mean systolic blood pressure being 121 ± 14 mmHg, mean LDL cholesterol of 2.8 mmol/l, 59% of patients received statins and 92% of patients received antiplatelet therapy. During a median follow-up of 33 months, β-blocker therapy was not associated with a reduction in cardiovascular events (hazard ratio 0.97; 95 % confidence interval 0.74-1.27), documented angina (hazard ratio 0.85; 95 % confidence interval 0.61-1.19) or any of the individual components of the combined endpoint. There were no relevant interactions for demographics, comorbidities or surgical characteristics. Propensity matched and time-dependent analyses revealed similar results.

Conclusions: β-blocker therapy after CABG is not associated with reductions in angina or cardiovascular events in low-risk patients with preserved LVEF, and may not be systematically indicated in such patients.

No MeSH data available.


Related in: MedlinePlus

Outcome according to β-blocker therapy – Cumulative event rates for composite endpoints stratified for β-blocker therapy. Hazard ratios are adjusted for age, gender, ethnicity, history of myocardial infarction, revascularization, non-cardiac vascular event, hypertension, diabetes, hypercholesterolemia, days after CABG (coronary artery bypass grafting), beating heart surgery, nr of vessel disease, complete revascularization, left ventricular ejection fraction and concomitant medication. MACE, Major Adverse Cardiovascular Event
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Fig1: Outcome according to β-blocker therapy – Cumulative event rates for composite endpoints stratified for β-blocker therapy. Hazard ratios are adjusted for age, gender, ethnicity, history of myocardial infarction, revascularization, non-cardiac vascular event, hypertension, diabetes, hypercholesterolemia, days after CABG (coronary artery bypass grafting), beating heart surgery, nr of vessel disease, complete revascularization, left ventricular ejection fraction and concomitant medication. MACE, Major Adverse Cardiovascular Event

Mentions: Out of the 2233 patients analysed, 299 (13.4 %) patients had experienced a primary event, while 451 (20.2 %) patients had experienced a secondary event during a median follow-up of 33 months (IQR 16–43). Total event count for MACE and Angina was 245 (11.0 %) and 191 (8.6 %) respectively. β-blocker treatment was not associated with a difference in cumulative incidence of any of the composite endpoints (primary endpoint, secondary endpoint, MACE, angina, (Fig. 1)). Multivariate regression did not reveal any association between β-blocker treatment and the primary endpoint (hazard ratio (HR) 0.97; 95 % confidence interval (CI) 0.74–1.27), documented angina (HR 0.85; 95%CI 0.61–1.19) or any of the other composite endpoints and their individual components (Fig. 2). The neutral effects of β-blocker therapy were consistent among several relevant subgroups including age, gender, hypertension, previous MI, completeness of revascularization and treatment allocation (Fig. 3).Fig. 1


β-blocker Therapy is Not Associated with Reductions in Angina or Cardiovascular Events After Coronary Artery Bypass Graft Surgery: Insights from the IMAGINE Trial.

Booij HG, Damman K, Warnica JW, Rouleau JL, van Gilst WH, Westenbrink BD - Cardiovasc Drugs Ther (2015)

Outcome according to β-blocker therapy – Cumulative event rates for composite endpoints stratified for β-blocker therapy. Hazard ratios are adjusted for age, gender, ethnicity, history of myocardial infarction, revascularization, non-cardiac vascular event, hypertension, diabetes, hypercholesterolemia, days after CABG (coronary artery bypass grafting), beating heart surgery, nr of vessel disease, complete revascularization, left ventricular ejection fraction and concomitant medication. MACE, Major Adverse Cardiovascular Event
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4522029&req=5

Fig1: Outcome according to β-blocker therapy – Cumulative event rates for composite endpoints stratified for β-blocker therapy. Hazard ratios are adjusted for age, gender, ethnicity, history of myocardial infarction, revascularization, non-cardiac vascular event, hypertension, diabetes, hypercholesterolemia, days after CABG (coronary artery bypass grafting), beating heart surgery, nr of vessel disease, complete revascularization, left ventricular ejection fraction and concomitant medication. MACE, Major Adverse Cardiovascular Event
Mentions: Out of the 2233 patients analysed, 299 (13.4 %) patients had experienced a primary event, while 451 (20.2 %) patients had experienced a secondary event during a median follow-up of 33 months (IQR 16–43). Total event count for MACE and Angina was 245 (11.0 %) and 191 (8.6 %) respectively. β-blocker treatment was not associated with a difference in cumulative incidence of any of the composite endpoints (primary endpoint, secondary endpoint, MACE, angina, (Fig. 1)). Multivariate regression did not reveal any association between β-blocker treatment and the primary endpoint (hazard ratio (HR) 0.97; 95 % confidence interval (CI) 0.74–1.27), documented angina (HR 0.85; 95%CI 0.61–1.19) or any of the other composite endpoints and their individual components (Fig. 2). The neutral effects of β-blocker therapy were consistent among several relevant subgroups including age, gender, hypertension, previous MI, completeness of revascularization and treatment allocation (Fig. 3).Fig. 1

Bottom Line: During a median follow-up of 33 months, β-blocker therapy was not associated with a reduction in cardiovascular events (hazard ratio 0.97; 95 % confidence interval 0.74-1.27), documented angina (hazard ratio 0.85; 95 % confidence interval 0.61-1.19) or any of the individual components of the combined endpoint.There were no relevant interactions for demographics, comorbidities or surgical characteristics.Propensity matched and time-dependent analyses revealed similar results. β-blocker therapy after CABG is not associated with reductions in angina or cardiovascular events in low-risk patients with preserved LVEF, and may not be systematically indicated in such patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, P O Box 30001, 9700 RB, Groningen, The Netherlands, hg.booij@umcg.nl.

ABSTRACT

Purpose: To evaluate whether β-blockers were associated with a reduction in cardiovascular events or angina after Coronary Artery Bypass Graft (CABG) surgery, in otherwise stable low-risk patients during a mid-term follow-up.

Methods: We performed a post-hoc analysis of the IMAGINE (Ischemia Management with Accupril post-bypass Graft via Inhibition of angiotensin coNverting Enzyme) trial, which tested the effect of Quinapril in 2553 hemodynamically stable patients with left ventricular ejection fraction (LVEF) >40 %, after scheduled CABG. The association between β-blocker therapy and the incidence of cardiovascular events (death, cardiac arrest, myocardial infarction, revascularizations, angina requiring hospitalization, stroke or hospitalization for heart failure) or angina that was documented to be due to underlying ischemia was tested with Cox regression and propensity adjusted analyses.

Results: In total, 1709 patients (76.5 %) were using a β-blocker. Patients had excellent control of risk factors; with mean systolic blood pressure being 121 ± 14 mmHg, mean LDL cholesterol of 2.8 mmol/l, 59% of patients received statins and 92% of patients received antiplatelet therapy. During a median follow-up of 33 months, β-blocker therapy was not associated with a reduction in cardiovascular events (hazard ratio 0.97; 95 % confidence interval 0.74-1.27), documented angina (hazard ratio 0.85; 95 % confidence interval 0.61-1.19) or any of the individual components of the combined endpoint. There were no relevant interactions for demographics, comorbidities or surgical characteristics. Propensity matched and time-dependent analyses revealed similar results.

Conclusions: β-blocker therapy after CABG is not associated with reductions in angina or cardiovascular events in low-risk patients with preserved LVEF, and may not be systematically indicated in such patients.

No MeSH data available.


Related in: MedlinePlus