Bisoprolol vs. Carvedilol After Percutaneous Coronary Intervention in Acute Myocardial Infarction With Reduced Left Ventricular Ejection Fraction

BACKGROUND: Beta-blocker therapy remains a cornerstone in the management of acute myocardial infarction (AMI) with reduced left ventricular ejection fraction (LVEF). However, evidence comparing clinical outcomes among different β-blocker types is limited. This study compared the 3-year cardiovascular outcomes between bisoprolol and carvedilol in patients with AMI and reduced LVEF who underwent percutaneous coronary intervention (PCI). METHODS AND RESULTS: Data were derived from the Korean Acute Myocardial Infarction Registry V (KAMIR-V), a prospective nationwide multicenter registry. Among 16,521 enrolled patients, those who did not undergo PCI, had non-reduced or unknown LVEF, were not prescribed β-blockers, or received other β-blocker types were excluded. In all, 1,062 patients were classified according to the β-blocker prescribed at discharge (bisoprolol, n=386; carvedilol, n=676). The primary endpoint was the 3-year patient-oriented composite endpoint (POCE) of all-cause death, any myocardial infarction, or any revascularization. During a median follow-up of 1,076 days (interquartile range 732-1,109 days), POCE occurred in 18.9% of the bisoprolol group and 16.3% of the carvedilol group (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.54-1.17; P=0.237). After propensity score matching, results were consistent (HR 0.88; 95% CI 0.62-1.24; P=0.470). CONCLUSIONS: Among patients with AMI and reduced LVEF undergoing PCI, bisoprolol and carvedilol showed comparable 3-year cardiovascular outcomes. Both agents appear to be suitable options for secondary prevention in this high-risk population.