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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

Propensity matched analysis – (a) standardized differences between baseline characteristics before and after matching. (b) Cumulative event rate for the primary endpoint in the propensity matched population. CABG, Coronary Artery Bypass Grafting; PCI, Percutaneous Coronary Intervention
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Fig4: Propensity matched analysis – (a) standardized differences between baseline characteristics before and after matching. (b) Cumulative event rate for the primary endpoint in the propensity matched population. CABG, Coronary Artery Bypass Grafting; PCI, Percutaneous Coronary Intervention

Mentions: The propensity matched population consisted of 424 patients per group. Absolute standardized differences for all baseline-characteristics were <10 %, indicating an adequate match (Fig 4a). There was no association between β-blocker therapy and the occurrence of the primary IMAGINE endpoint when adjusting for propensity score and its covariates in the unmatched population nor when the propensity matched population was considered separately (Figs. 4b and 5). Similar results were obtained for the secondary endpoint, MACE and angina (data not shown). To account for differences in treatment over time, we analysed β-blocker therapy as a time-dependent covariate in our Cox-regression models. Again, no association was found for β-blocker therapy and outcome (Fig. 5).Fig. 4


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)

Propensity matched analysis – (a) standardized differences between baseline characteristics before and after matching. (b) Cumulative event rate for the primary endpoint in the propensity matched population. CABG, Coronary Artery Bypass Grafting; PCI, Percutaneous Coronary Intervention
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4522029&req=5

Fig4: Propensity matched analysis – (a) standardized differences between baseline characteristics before and after matching. (b) Cumulative event rate for the primary endpoint in the propensity matched population. CABG, Coronary Artery Bypass Grafting; PCI, Percutaneous Coronary Intervention
Mentions: The propensity matched population consisted of 424 patients per group. Absolute standardized differences for all baseline-characteristics were <10 %, indicating an adequate match (Fig 4a). There was no association between β-blocker therapy and the occurrence of the primary IMAGINE endpoint when adjusting for propensity score and its covariates in the unmatched population nor when the propensity matched population was considered separately (Figs. 4b and 5). Similar results were obtained for the secondary endpoint, MACE and angina (data not shown). To account for differences in treatment over time, we analysed β-blocker therapy as a time-dependent covariate in our Cox-regression models. Again, no association was found for β-blocker therapy and outcome (Fig. 5).Fig. 4

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