Fukase T, Dohi T, Koike T, et al. - Among elderly patients with coronary artery disease (CAD) without myocardial infarction (MI) or systolic heart failure (HF), long-term β-blocker use was identified to be significantly related to an elevated risk of adverse cardiovascular events. Particularly, β-blockers’ chronotropic incompetence action could raise the risk of admission for HF in this patient population.

• A total of 1,018 elderly patients with CAD (mean age, 72 ± 7 years; 77% men) without MI or systolic HF who have undergone percutaneous coronary intervention were allocated to the β-blocker group [n=514 patients (50.5%)] or to the non-β-blocker group [n=504 (49.5%)] based on the presence or absence of the use of β-blockers.

• Four-point major adverse cardiovascular events (4P-MACE) occurred in 8.3% of the patients during a median follow-up of 5.1 years.

• A significantly higher cumulative incidence rate of 4P-MACE was reported in the β-blocker group vs non-β-blocker group (15.4% vs 10.0%), in the Kaplan–Meier analysis.

• Also, significantly higher cumulative incidence rate of admission for HF was noted in the β-blocker group (8.8% vs 3.2%).

• There was significantly lower resting heart rate, stress heart rate, and stress-rest Δ heart rate on exercise electrocardiogram in the β-blocker group.

• Strong independent predictors of admission for HF included: EF, β-blocker use, stress-rest Δ heart rate, and chronic kidney disease.