Beta-blocker Treatment Does Not Worsen Critical Limb Ischemia in Patients Receiving Endovascular Therapy

Abstract

Aim: It has been reported that beta-blockers (BB) reduce cardiovascular events in patients with atherosclerotic disease. However, little is known about the efficacy of these drugs in patients with critical limb ischemia (CLI). We investigated whether beta-blocker therapy affects the clinical outcomes of CLI patients. Methods: Between March 2004 and December 2011, 1,873 consecutive CLI patients who received endovascular therapy (EVT) (394 BB-treated patients and 1,479 non-BB-treated patients) for de novo infrainguinal lesions were identified retrospectively. A propensity score analysis was used for risk adjustment in a multivariable analysis and one-to-one matching (BB: 305, non-BB 305). The primary endpoint was amputation-free survival (AFS), and the secondary endpoints were overall survival and the rates of limb salvage and freedom from major adverse limb events (MALE; including repeat reintervention, surgical conversion and major amputation). The mean follow-up period was 22 15 months. Results: In the propensity score-matched pair analysis, there were no significant differences in AFS between the patients treated with and without beta-blockers (58.8% vs. 58.5% at three years, logrank p 0.76). There were also no significant differences in the limb salvage rate (88.3% vs. 88.8 at three years, log-rank P 0.41), overall survival (63.0% vs. 62.4% at three years, log-rank P 0.70) and freedom from MALE (43.6% vs. 44.9% at three years, log-rank P 0.58) between the patients treated with and without beta-blockers. Conclusions

The position of Polish experts on conservative management in patients with artery diseases of lower limbs

“…Using drugs from this class did not affect the claudication distance in patients with mild or moderate LEAD [63]. However, caution is recommended when using those drugs in patients with critical ischemia, despite the fact that in the observational studies, even in patients with CLTI the clinical outcomes of treatment were non-inferior among the patients treated with beta-adrenolytics to patients not receiving those drugs [64,65].…”

ESVM Guideline on peripheral arterial disease

“…Studies in hypertension show somewhat less reduction in cardiovascular events with beta blockers than with other antihypertensive drug classes. Of note, beta blockers are well tolerated in PAD patients and are not contraindicated [196][197][198]. Thus, beta blockers are useful in PAD patients with concomitant cardiovascular disorders, where they are indicated.…”

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

“…Stwierdzono przewagę nebiwololu pod wzglę-dem istotnej poprawy dystansu chodu do wystąpienia bólu (+34%; p < 0,003 vs. +17%; p < 0,12 w grupie leczonej metoprololem). W jednoośrodkowym badaniu obejmują-cym 1873 kolejnych pacjentów z CLTI, których poddano leczeniu wewnątrznaczyniowemu, wśród pacjentów leczonych innymi beta-adrenolitykami nie stwierdzono gorszych klinicznych wyników leczenia [266]. W wielośrodkowym rejestrze obejmującym 1273 pacjentów hospitalizowanych z powodu ciężkiej LEAD (wśród których u 65% występowało CLTI, a 28% leczono beta-adrenolitykiem) częstość zgonów i amputacji nie różniła się między pacjentami leczonymi lub nieleczonymi beta-adrenolitykiem [267].…”