Association between Early Oral β-Blocker Therapy and Risk for In-Hospital Major Bleeding after Percutaneous Coronary Intervention for Acute Coronary Syndrome: Findings from CCC-ACS Project

Shaopeng Xu; Ziping Li; Tianqi Yang; Linjie Li; Xiwen Song; Yongchen Hao; Sidney C Smith; Gregg C Fonarow; Louise Morgan; Jing Liu; Jun Liu; Dong Zhao; Qing Yang; Xin Zhou; Yongle Li

doi:10.1093/ehjqcco/qcac036

Association between Early Oral β-Blocker Therapy and Risk for In-Hospital Major Bleeding after Percutaneous Coronary Intervention for Acute Coronary Syndrome: Findings from CCC-ACS Project

Eur Heart J Qual Care Clin Outcomes. 2022 Jun 17:qcac036. doi: 10.1093/ehjqcco/qcac036. Online ahead of print.

Authors

Shaopeng Xu¹, Ziping Li¹, Tianqi Yang¹, Linjie Li¹, Xiwen Song¹, Yongchen Hao², Sidney C Smith³, Gregg C Fonarow⁴, Louise Morgan⁵, Jing Liu², Jun Liu², Dong Zhao², Qing Yang¹, Xin Zhou¹, Yongle Li¹

Affiliations

¹ Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China.
² Departments of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
³ Division of Cardiology, University of North Carolina, Chapel Hill, NC.
⁴ Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, CA.
⁵ International Quality Improvement Department, American Heart Association, Dallas, TX.

PMID: 35713509
DOI: 10.1093/ehjqcco/qcac036

Abstract

Aims: Information regarding β-blocker use and bleeding risk in patients on antithrombotic therapy in contemporary practice is limited. We examined the association between early (within the first 24 hours) oral β-blocker therapy and major in-hospital bleeds among acute coronary syndrome (ACS) patients treated with percutaneous coronary intervention (PCI).

Methods and results: In the Improving Care for Cardiovascular Disease in China-ACS project, among patients without contraindications to β-blocker, we examined the association between early oral β-blocker exposure [users/non-users, dosing, and type (metoprolol vs. bisoprolol)] and major in-hospital bleeds. Of the 43,640 eligible patients, 36.0% patients received early oral β-blocker and 637 major bleeds were recorded. Compared with non-users, early oral β-blocker was associated reduced risks for major bleeds [odds ratio (OR): 0.48; 95% confidence interval (CI): 0.38-0.61] and in-hospital mortality (OR: 0.47; 95%CI: 0.34-0.64) in multivariable-adjusted logistic regression models. Early oral β-blocker use associated reduction in major bleeding was evident both in high-dose (defined by metoprolol-equivalent dose ≥50 mg/day) users (OR: 0.47; 95%CI: 0.33-0.68) and in low-dose users (metoprolol-equivalent dose <50 mg/day; OR: 0.61; 95%CI: 0.47-0.79). No significant difference was observed between metoprolol and bisoprolol in terms of reductions in major bleeding and mortality. Analyses based on inverse-probability-of-treatment-weighted regression adjustment and propensity-score matching yielded consistent findings.

Conclusion: In this retrospective study based on the nationwide ACS registry, among patients treated by PCI, in addition to a reduction in in-hospital mortality, oral β-blocker therapy initiated within the first 24 hours was associated with a reduced risk for major in-hospital bleeds. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02306616.

Keywords: Acute Coronary Syndrome; Bleeding; Percutaneous Coronary Intervention; β-blocker.

Associated data

ClinicalTrials.gov/NCT02306616