Long-term clinical outcomes of carvedilol versus nebivolol in patients with ST-segment elevation myocardial infarction treated with second-generation drug-eluting stents: insights from a Korean nationwide multicenter prospective registry.

Background: Owing to the limited head-to-head comparative evidence between vasodilating Methods: Data were obtained from the Korea Acute Myocardial Infarction Registry (KAMIR), including the KAMIR-National Institutes of Health (NIH) and KAMIR-V cohorts (2011-2020). Patients with STEMI who underwent successful PCI with second-generation DES and received either carvedilol or nebivolol were retrospectively analyzed. The primary endpoint was 3-year major adverse cardiac events (MACE). Secondary endpoints included individual MACE components, stent thrombosis, and heart failure-related rehospitalization. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. Results: A total of 6,752 eligible patients with STEMI were identified, baseline differences were effectively minimized using IPTW analysis. Over a median follow-up of 3 years, nebivolol was associated with a higher MACE risk compared with carvedilol (11.1% vs. 9.6%; hazard ratio [HR] 1.176, 95% confidence interval [CI] 1.052-1.314, Conclusions: In this contemporary cohort of patients with STEMI treated with DES, carvedilol was associated with better long-term clinical outcomes, including lower risks of MACE and all-cause mortality, compared with nebivolol.