Long-term clinical outcome between beta-blocker with ACEI or ARB in patients with NSTEMI who underwent PCI with drug-eluting stents

Background Because limited comparative data are available, we decided to compare 2-year major clinical outcomes between beta-blockers (BB) with angiotensin converting enzyme inhibitors (ACEI) and BB with angiotensin receptor blockers (ARB) therapy in patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Methods A total 11,288 NSTEMI patients who underwent PCI with DES were enrolled and they were divided into two groups, the BB with ACEI group (n = 7600) and the BB with ARB group (n = 3688). The major clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total revascularization target lesion revascularization (TLR), target vessel revascularization (TVR), non-TVR rate during the 2-year follow-up period. Results After propensity score-matched (PSM) analysis, two PSM groups (3317 pairs, n = 6634, C-statistic = 0.695) were generated. Although the cumulative incidences of all-cause death, cardiac death, TLR, and non-TVR were similar between the two groups, MACE (HR = 0.832, 95% CI: 0.704-0.982, P = 0.030), total revascularization rate (HR = 0.767, 95% CI: 0.598-0.984, P = 0.037), and TVR rate (HR = 0.646, 95% CI: 0.470-0.888, P = 0.007) were significantly lower in the BB with ACEI group after PSM. Conclusions In this study, we suggest that the combination of BB with ACEI may be beneficial for reducing the cumulative incidences of MACE, total revascularization rate, and TVR rather than the BB with ARB after PCI with DES in NSTEMI patients.