Beta-blockers (BB) are routinely prescribed following coronary events, primarily based on evidence from populations with systolic dysfunction. Their benefit in patients with preserved left ventricular ejection fraction (LVEF) remains uncertain. This nested case-control study, published in the Current Problems in Cardiology, examined the association between BB prescription and all-cause mortality following percutaneous coronary intervention (PCI), stratified by LVEF categories.

Data were derived from the Victorian Cardiac Outcomes Registry linked to the Australian National Death Index (2014–2022). Adults discharged alive after PCI were included. Patients were categorized by LVEF as preserved (≥50%), mildly reduced (45–49%), moderately reduced (35–44%), and severely reduced (<35%). 

Propensity score matching and logistic regression with cluster-robust standard errors were applied. Sensitivity analyses assessed the impact of missing LVEF data and 30-day cardiovascular mortality.

Among 71,053 patients, 67.3% received BB therapy. After matching, BB use was associated with higher odds of all-cause mortality in patients with preserved LVEF (odds ratio [OR] 1.46; 95% confidence interval [CI] 1.29-1.65) and mildly reduced LVEF (OR 1.48; 95% CI 1.15-1.91). No significant mortality benefit was observed in patients with moderately or severely reduced LVEF. Subgroup analyses across clinical contexts and sensitivity analyses were consistent with the primary findings.

BB therapy following PCI was not associated with mortality benefit across LVEF groups. Increased mortality odds were observed in preserved and mildly reduced LVEF categories.