Long-term clinical outcomes of carvedilol versus nebivolol in patients with ST-segment elevation myocardial infarction treated with second-generation drug-eluting stents: insights from a Korean nationwide multicenter prospective registry.

BACKGROUND: Owing to the limited head-to-head comparative evidence between vasodilating β-blockers, this study aimed to assess long-term clinical outcomes of nebivolol vs. carvedilol in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES). METHODS: Data were obtained from the Korea Acute Myocardial Infarction Registry (KAMIR), including the KAMIR-National Institutes of Health (NIH) and KAMIR-V cohorts (2011-2020). Patients with STEMI who underwent successful PCI with second-generation DES and received either carvedilol or nebivolol were retrospectively analyzed. The primary endpoint was 3-year major adverse cardiac events (MACE). Secondary endpoints included individual MACE components, stent thrombosis, and heart failure-related rehospitalization. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. RESULTS: A total of 6,752 eligible patients with STEMI were identified, baseline differences were effectively minimized using IPTW analysis. Over a median follow-up of 3 years, nebivolol was associated with a higher MACE risk compared with carvedilol (11.1% vs. 9.6%; hazard ratio [HR] 1.176, 95% confidence interval [CI] 1.052-1.314, p = 0.005). All-cause mortality (4.4% vs. 3.4%; HR: 1.315, 95% CI: 1.102-1.569, p = 0.002) and revascularization (7.0% vs. 6.2%, p = 0.043; HR: 1.15, 95% CI: 1.00-1.32, p = 0.043) were also higher in the nebivolol group compared with carvedilol. CONCLUSIONS: In this contemporary cohort of patients with STEMI treated with DES, carvedilol was associated with better long-term clinical outcomes, including lower risks of MACE and all-cause mortality, compared with nebivolol.