Impact of beta-blocker Nebivolol versus Carvedilol prescription at discharge on long-term clinical outcomes in STEMI patients with preserved LVEF treated with drug-eluting stents

Abstract Background Nebivolol and Carvedilol are third-generation β-blockers with different pharmacological properties. While Nebivolol offers selective β1-blockade and nitric oxide-mediated vasodilation, Carvedilol is a non-selective β-blocker with additional antioxidant effects. This study aimed to compare the long-term outcomes of these two β-blockers in ST-segment elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF ≥50%) treated with drug-eluting stents (DESs). Methods We analyzed data from the Korea Acute Myocardial Infarction Registry (KAMIR) involving STEMI patients with preserved LVEF treated with DESs. Patients were grouped based on discharge prescription of Nebivolol or Carvedilol and followed for up to 3 years. The primary endpoint was all-cause death, while the secondary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction (MI), and revascularization. Inverse probability of treatment weighting (IPTW) was used to adjust for confounders. Results After IPTW adjustment, baseline characteristics were well balanced between the Nebivolol group (n=3,295) and the Carvedilol group (n=3,416). At 1 year, the incidence of total death was significantly higher in the Nebivolol group compared to the Carvedilol group (1.7% vs. 0.8%, HR: 2.055, 95% CI: 1.311–3.223, P=0.002). There was a trend toward higher incidence of MACE in the Nebivolol group (5.1% vs. 4.1%, HR: 1.258, 95% CI: 0.999–1.584, P=0.053). Over the 3-year follow-up, the incidence of total death (3.3% vs. 2.4%, HR: 1.391, 95% CI: 1.040–1.860, P=0.027) and MACE (10.5% vs. 8.4%, HR: 1.270, 95% CI: 1.078–1.497, P=0.004) remained significantly higher in the Nebivolol group. Conclusions In STEMI patients with preserved LVEF treated with DESs, Carvedilol was associated with a significantly lower risk of all-cause death and MACE at both 1 and 3 years compared to Nebivolol. These findings suggest that Carvedilol may offer superior long-term clinical benefits in this population.