Bisoprolol vs. Carvedilol After Percutaneous Coronary Intervention in Acute Myocardial Infarction With Reduced Left Ventricular Ejection Fraction.

BACKGROUND

Beta-blocker therapy remains a cornerstone in the management of acute myocardial infarction (AMI) with reduced left ventricular ejection fraction (LVEF). However, evidence comparing clinical outcomes among different β-blocker types is limited. This study compared the 3-year cardiovascular outcomes between bisoprolol and carvedilol in patients with AMI and reduced LVEF who underwent percutaneous coronary intervention (PCI).

METHODS AND

RESULTS

Data were derived from the Korean Acute Myocardial Infarction Registry V (KAMIR-V), a prospective nationwide multicenter registry. Among 16,521 enrolled patients, those who did not undergo PCI, had non-reduced or unknown LVEF, were not prescribed β-blockers, or received other β-blocker types were excluded. In all, 1,062 patients were classified according to the β-blocker prescribed at discharge (bisoprolol, n=386; carvedilol, n=676). The primary endpoint was the 3-year patient-oriented composite endpoint (POCE) of all-cause death, any myocardial infarction, or any revascularization. During a median follow-up of 1,076 days (interquartile range 732-1,109 days), POCE occurred in 18.9% of the bisoprolol group and 16.3% of the carvedilol group (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.54-1.17; P=0.237). After propensity score matching, results were consistent (HR 0.88; 95% CI 0.62-1.24; P=0.470).

CONCLUSIONS

Among patients with AMI and reduced LVEF undergoing PCI, bisoprolol and carvedilol showed comparable 3-year cardiovascular outcomes. Both agents appear to be suitable options for secondary prevention in this high-risk population.