β1-blockers in the reduction of bleeding risk in patients prescribed with potent dual antiplatelet therapy after acute coronary syndrome or percutaneous coronary intervention

Shizhao Zhang; Yangxun Wu; Chao Lv; Haiping Liu; Yuyan Wang; Lisha Dong; Yuqi Liu; Shengshu Wang; Jianjun Jia; Tong Yin

doi:10.1016/j.hjc.2023.09.017

β1-blockers in the reduction of bleeding risk in patients prescribed with potent dual antiplatelet therapy after acute coronary syndrome or percutaneous coronary intervention

Hellenic J Cardiol. 2023 Oct 12:S1109-9666(23)00188-4. doi: 10.1016/j.hjc.2023.09.017. Online ahead of print.

Authors

Shizhao Zhang¹, Yangxun Wu¹, Chao Lv¹, Haiping Liu¹, Yuyan Wang¹, Lisha Dong¹, Yuqi Liu¹, Shengshu Wang¹, Jianjun Jia², Tong Yin³

Affiliations

¹ Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, No.28 Fu Xing Road, Beijing 100853, China; Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.
² Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, No.28 Fu Xing Road, Beijing 100853, China; Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China. Electronic address: jiajianjun301@126.com.
³ Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, No.28 Fu Xing Road, Beijing 100853, China; Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China. Electronic address: yintong301@163.com.

PMID: 37783287
DOI: 10.1016/j.hjc.2023.09.017

Abstract

Background: β1-blockers could improve clinical outcomes in patients with coronary artery disease by lowering the heart rate, blood pressure, and myocardial contractility. Moreover, recent studies have suggested that β1-blockers may also have the potential to reduce bleeding risk.

Objectives: This study aimed to evaluate the association between β1-blockers and bleeding risk in the patients prescribed with potent dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI).

Methods: Patients with ACS or undergoing PCI treated by DAPT of ticagrelor and aspirin were consecutively recruited. Follow-up for all eligible patients was conducted for 1 year. Major bleeding outcomes were defined as events that were type ≥2 based on the Bleeding Academic Research Consortium (BARC) criteria.

Results: A total of 1,113 eligible ticagrelor-treated patients were recruited. During the 1-year follow-up interval, 142 (12.6%) patients experienced BARC ≥2 bleedings including 23 patients (2.1%) suffering BARC ≥3 bleedings, with the most common site of bleeding located in the gastrointestinal tract. β1-blockers treatment was associated with a lower risk of BARC ≥2 bleedings (11.2% vs. 23.3%, adjusted HR: 0.42, 95% CI: 0.28-0.62, P < 0.01). Moreover, metoprolol (11.1% vs. 23.3%, adjusted HR: 0.56, 95% CI: 0.37-0.83, P < 0.01) and bisoprolol (11.3% vs. 23.3%, adjusted HR: 0.56, 95% CI: 0.33-0.96, P = 0.04) had similar effects on the reduction of bleeding risk.

Conclusion: β1-blockers might be beneficial for the reduction of bleeding risk in potent dual antiplatelet therapy patients with ACS or undergoing PCI.

Keywords: acute coronary syndrome; bleeding; percutaneous coronary intervention; ticagrelor; β1-blockers.