Methods:

The authors performed a post hoc analysis of the CLARIFY (prospeCtive observational LongtudinAl RegIstry oF patients with stable coronary arterY disease) registry to evaluate the association between beta-blocker or calcium antagonist use and clinical outcomes. Patients with stable CAD (n = 32,703) in 45 countries were enrolled between November 2009 and June 2010, and followed annually for up to 5 years. Patients with ≥1 of the following criteria were eligible for enrollment: documented myocardial infarction (MI) >3 months prior; coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) >3 months prior; chest pain with proven myocardial ischemia; and prior coronary angiography with ≥1 coronary stenosis >50%. Exclusion criteria were hospitalization for cardiovascular disease within 3 months of planned enrollment, planned revascularization, and conditions that would interfere with life expectancy (e.g., severe heart failure). The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality and a composite of cardiovascular mortality and nonfatal MI. Beta-blocker and calcium antagonist use was assessed at baseline and yearly. Patients with prior MI were subdivided into groups based on the time from MI to enrollment in CLARIFY. Hazard ratios (HRs) associated with beta-blocker use versus nonuse and calcium antagonist use versus nonuse were calculated from Cox proportional hazards models. HRs were adjusted for cardiovascular risk factors, medical history of cardiovascular disease, treatments, geographical area, pulmonary comorbidities, blood pressure, left ventricular ejection fraction, history of revascularization, chronic obstructive pulmonary disease, and the REACH cardiovascular event risk score (adjusting for sex, age, smoking, diabetes, body mass index, extent of vascular disease, history of MI, heart failure, atrial fibrillation, statin or aspirin therapies, and geographical zone).