Do beta-blockers and renin-angiotensin system inhibitors reduce the risk of events after coronary revascularization?

This study investigated if certain types of anti-hypertensive drugs (AHTs) reduce risks after revascularization procedures for a heart attack.

They found that beta-blockers (BBs) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) reduce cardiovascular events (CVEs) after revascularization.

A heart attack is caused by blockages in the coronary arteries (blood vessels that supply the heart). Revascularization procedures are used to remove blockages. These include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). PCI involves using a catheter to remove the blockage in the coronary artery. It can also implant a stent (thin tube) into the blocked blood vessel to keep it open. CABG involves diverting blood flow around the blocked blood vessels.

Preventing further heart attacks is the aim of treatment after a PCI. There are several ways to do this. Medication that reduces blood pressure is one option. These drugs are called anti-hypertensive (AHT) drugs. AHT drugs have been used to reduce the risk of major adverse cardiac events (MACE) such as another heart attack, a stroke, or death due to heart problems after MI. There are several types of AHT drugs. Beta-blockers (BBs) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are often prescribed.

However, the benefit of different types of AHTs in patients that undergo PCI is not clear.

This study included 15,073 patients who had a heart attck. 94% of patients underwent PCI, while 6.8% had CABG. 20.9% of the patients were treated with BBs, 7.4% with ACEIs/ARBs, and 68.8% with a combination of both. 4.9% of the patients were not treated with any of the 2 drug types. The main outcome was the rate of MACE, heart failure, or mortality. 

At 12 months 11.1% of all patients reported a MACE. BB use was associated with a 31% lower mortality rate and a 20% lower MACE rate at 12 months. ACEI/ARB use was associated with a 20% lower mortality rate and a 20% lower rate of hospitalization for heart failure. 

Treatment with both BBs and ACEIs/ARBs was associated with a 30% lower risk of MACE and a 45% lower risk of all-cause mortality. It was also associated with a 76% lower risk of hospitalization for heart failure.

The authors concluded that BBs and ACEIs/ARBs reduce risks of MACE and mortality after revascularization for a heart attack compared to using neither drug.

This study was based on medical records. Some data was not available. Other factors could influence MACE and mortality risks. Treatment was at the doctor’s discretion. The long-term effect of AHTs after revascularization is not clear. 

If you have any concerns regarding coronary artery disease management please discuss this with your doctor.