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Aim   To evaluate the clinical impact of  β -blocker in patients with adequate left ventricular ejection function (LVEF) who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).Methods   A total of 10,724 consecutive patients who underwent PCI throughout 2013 were prospectively enrolled in the study. Among these, we analyzed 5,631 ACS patients who were discharged with LVEF ≥ 40%. Patients were then compared according to the  β -blocker prescription at discharge.Results   During a 2-year follow-up, no significant association was observed of  β -blocker use with all-cause mortality (with  β -blockers 47/5,043 (0.9%)  vs.  without  β -blocker use 8/588 (1.4%); hazard ratio (HR) 0.762, 95% confidence interval 0.36 to 1.64;  P  = 0.485), cardiac death, myocardial infarction (MI), or major adverse cardiovascular and cerebrovascular events. Subgroup analysis demonstrated that the  β -blocker use at discharge reduced the 2-year mortality in patients with unstable angina (UA) (HR 0.42, 95% CI 0.19 to 0.94,  P  = 0.034). Landmark analysis at 1 year showed that patients with UA who were discharged with  β -blockers had lower mortality (HR 0.17, 95% CI 0.04-0.65,  P  = 0.010) and cardiac death (HR 0.12, 95% CI 0.01-0.99,  P  = 0.049) than those discharged without  β -blockers. However, the benefit was lost beyond 1 year. No differences in outcomes were recorded in the AMI or overall population.Conclusions   We present that  β- blocker significantly lowers the rate of all-cause death up to 1 year, in UA patients who have undergone PCI and have adequate LVEF. Its role in patients with AMI also deserves further exploration.

Association of β-Blocker Therapy at Discharge with Clinical Outcomes after Acute Coronary Syndrome in Patients without Heart Failure