Association of β-blocker therapy with long-term clinical outcomes in patients with coronary chronic total occlusion

There are limited data regarding the efficacy of beta-blockers for secondary prevention in patients with coronary chronic total occlusion (CTO). Therefore, we investigated the association of beta-blocker therapy with long-term clinical outcomes in CTO patients. From March 2003 to February 2012, a total of 2024 CTO patients treated with either medical therapy alone or revascularization were enrolled in the study. We assessed 1596 patients with stable ischemic heart disease and divided them into the beta-blocker group (n=932) and the no-beta-blocker group (n=664). The primary outcome was all-cause death. The median follow-up duration was 3.9 (interquartile range: 2.0-6.2) years. All-cause death occurred in 11.6% patients in the beta-blocker group and 13.6% patients in the no-beta-blocker group (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.61-1.08; P=0.15). In the propensity score-matched population (570 pairs), all-cause death occurred in 12.3% patients in the beta-blocker group and 12.8% patients in the no-beta-blocker group (HR: 0.93, 95% CI: 0.67-1.29; P=0.66). In subgroup analysis, beta-blocker therapy was associated with better outcome, in terms of all-cause death, in patients with CTO of the left anterior descending coronary artery and Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) score >= 23 (P for interaction=0.01 and 0.02, respectively). In conclusion, beta-blocker therapy was not associated with favorable long-term clinical outcomes in stable CTO patients, regardless of treatment strategy. However, beta-blocker therapy might be beneficial in a highly selective group of CTO patients with a high ischemic burden.