Beta-Blockers Reduce The Incidence of Clinical Restenosis
Beta-Blockers Reduce The Incidence of Clinical Restenosis
Background: Restenosis after percutaneous transluminal coronary intervention (PCI) remains a serious complication in the treatment of coronary artery disease. Although
-adrenergic receptor blockers (BBs) effectively reduce many cardiac events, no large prospective studies have examined the association of BBs with restenosis.
Methods: We prospectively evaluated the association of BBs (prescribed at hospital discharge) with clinical restenosis in 4840 patients who underwent stent placement (60%), balloon angioplasty (32%), or rotational atherectomy (8%). Clinical restenosis was defined as repeat target lesion revascularization or coronary artery bypass grafting within 6 months of PCI. Other end points included 9-month clinical restenosis, repeat target lesion PCI (only), long-term (5-year) target lesion repeat-PCI, and major adverse cardiac events (MACE). Multivariable regression adjusted the effect of BBs on clinical restenosis for 15 covariables.
Results: The average patient age was 63 years, 75% were men, and 37% received a BB prescription. The incidence of clinical restenosis was 12% overall and was lower among those prescribed a BB (10.0% for BB, 13.5% for none, adjusted odds ratio [OR] 0.76, P = .004). Other predictors of decreased restenosis included stent use, age, and smoking; predictors of increased restenosis included diabetes, atherectomy, and number of treated vessels. BBs also reduced 9-month clinical restenosis (10.3% vs 13.5%, OR 0.75, P = .004), MACE (16.5% vs 20.9%, OR 0.75, P < .001), 6-month target lesion restenosis (7.8% vs 10.2%, OR 0.75, P = .006), and 5-year target lesion restenosis (12.0% vs 14.0%, OR 0.83, P = .046).
Conclusions:
-Adrenergic receptor blockers prescribed after PCI reduced the risk of clinical restenosis, target lesion restenosis, and MACE in this cohort of 4840 patients. The mechanism by which
-blockers conferred a protective effect against restenosis remains to be determined.
Restenosis continues to be the major limitation of percutaneous coronary intervention (PCI). Restenosis complicates up to 40% of angioplasty procedures, particularly within the first 6 months. The mechanisms of restenosis are only partially understood but include vascular remodeling, recoil of the vessel, and the normal healing process in response to arterial injury and smooth muscle cell proliferation. Pharmacological approaches to reduce restenosis after PCI have been largely ineffective.
-Adrenergic blockers (
-blockers [BB]), commonly used in patients with coronary artery disease (CAD), have been largely overlooked in restenosis prevention, and a few earlier studies addressing their potential utility have been negative.
Previous studies have been disappointing. In vitro BBs did not inhibit smooth muscle proliferation. Likewise clinically, in an older study of 541 patients who underwent balloon PCI, BBs did not appear to influence restenosis. In a more recent study of directional coronary atherectomy in 401 patients, carvedilol did not affect angiographic restenosis. Despite these negative results, PCI has evolved and stenting has emerged as the dominant approach. Therefore, we postulated that through their hemodynamic effects, BBs might beneficially affect restenosis after PCI with stenting. To reinvestigate the role of BBs after PCI as currently used and to determine if a differential effect based on treatment approach exists, we prospectively evaluated clinical restenosis in 4840 patients who underwent PCI, whose BB status was known, and who were followed for at least 6 months.
Background: Restenosis after percutaneous transluminal coronary intervention (PCI) remains a serious complication in the treatment of coronary artery disease. Although
-adrenergic receptor blockers (BBs) effectively reduce many cardiac events, no large prospective studies have examined the association of BBs with restenosis.
Methods: We prospectively evaluated the association of BBs (prescribed at hospital discharge) with clinical restenosis in 4840 patients who underwent stent placement (60%), balloon angioplasty (32%), or rotational atherectomy (8%). Clinical restenosis was defined as repeat target lesion revascularization or coronary artery bypass grafting within 6 months of PCI. Other end points included 9-month clinical restenosis, repeat target lesion PCI (only), long-term (5-year) target lesion repeat-PCI, and major adverse cardiac events (MACE). Multivariable regression adjusted the effect of BBs on clinical restenosis for 15 covariables.
Results: The average patient age was 63 years, 75% were men, and 37% received a BB prescription. The incidence of clinical restenosis was 12% overall and was lower among those prescribed a BB (10.0% for BB, 13.5% for none, adjusted odds ratio [OR] 0.76, P = .004). Other predictors of decreased restenosis included stent use, age, and smoking; predictors of increased restenosis included diabetes, atherectomy, and number of treated vessels. BBs also reduced 9-month clinical restenosis (10.3% vs 13.5%, OR 0.75, P = .004), MACE (16.5% vs 20.9%, OR 0.75, P < .001), 6-month target lesion restenosis (7.8% vs 10.2%, OR 0.75, P = .006), and 5-year target lesion restenosis (12.0% vs 14.0%, OR 0.83, P = .046).
Conclusions:
-Adrenergic receptor blockers prescribed after PCI reduced the risk of clinical restenosis, target lesion restenosis, and MACE in this cohort of 4840 patients. The mechanism by which
-blockers conferred a protective effect against restenosis remains to be determined.
Restenosis continues to be the major limitation of percutaneous coronary intervention (PCI). Restenosis complicates up to 40% of angioplasty procedures, particularly within the first 6 months. The mechanisms of restenosis are only partially understood but include vascular remodeling, recoil of the vessel, and the normal healing process in response to arterial injury and smooth muscle cell proliferation. Pharmacological approaches to reduce restenosis after PCI have been largely ineffective.
-Adrenergic blockers (
-blockers [BB]), commonly used in patients with coronary artery disease (CAD), have been largely overlooked in restenosis prevention, and a few earlier studies addressing their potential utility have been negative.
Previous studies have been disappointing. In vitro BBs did not inhibit smooth muscle proliferation. Likewise clinically, in an older study of 541 patients who underwent balloon PCI, BBs did not appear to influence restenosis. In a more recent study of directional coronary atherectomy in 401 patients, carvedilol did not affect angiographic restenosis. Despite these negative results, PCI has evolved and stenting has emerged as the dominant approach. Therefore, we postulated that through their hemodynamic effects, BBs might beneficially affect restenosis after PCI with stenting. To reinvestigate the role of BBs after PCI as currently used and to determine if a differential effect based on treatment approach exists, we prospectively evaluated clinical restenosis in 4840 patients who underwent PCI, whose BB status was known, and who were followed for at least 6 months.