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    Efficacy of beta-blocker agents on clinical outcomes in patients with thoracic aortic aneurysm: A systematic review and meta-analysis of randomized controlled trials
    (Elsevier Science Inc, 2025) Tanriverdi, Lokman H.; Barrett, Annie; Kalyanasundaram, Asanish; Zafar, Mohammad A.; Ziganshin, Bulat A.; Elefteriades, John A.
    Objective: Studies investigating the efficacy of beta-blocker agents for patients with thoracic aortic aneurysm (TAA) have produced heterogeneous and conflicting results. We assess the effects of beta-blockers on clinical outcomes in patients with TAA. Methods: A systematic literature search was performed through Ovid MEDLINE, EMBASE, Web of Science, Pubmed and Cochrane CENTRAL, all from inception to April 30, 2024. Randomized controlled trials (RCTs) exploring the effect of beta-blocker agents in patients with TAA were considered for inclusion, with no population restriction. Inverse variance-weighted random-effects model was used. The overall risk of bias assessment was conducted by Cochrane Risk of Bias 2 tool. The primary outcome was aortic events during follow-up. Results: We included a total of 161 patients with TAA (mean age, 27.6 years; 80 [49.7 %] male, mean follow-up 6.7 years) in 4 RCTs. The pooled risk ratio in the beta-blocker arm for aortic events was 0.74 [95 % CI (0.20; 2.71), I-2: 0 %, p = 0.64, low certainty of evidence (CoE)] when compared to placebo or no treatment in patients with TAA. The pooled risk ratios for aortic dissection or death (all-cause mortality) or in the beta-blocker arm were 0.45 (95 % CI (0.10; 1.98), I-2: 0 %, p = 0.29, low CoE) and 0.58 (95 % CI (0.15; 2.24), I-2: 0 %, p = 0.43, low CoE), respectively. The risks of aortic dissection, rupture, or death were comparable, regardless of agent, disease, and age. Conclusion: We found no evidence of benefit from beta-blocker treatment for patients with TAA. More robust RCTs are needed to establish evidence-based recommendations.