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Long-Term Beta-Blocker Therapy After AMI Without HF
Quick Takes
- This nationwide cohort study reports that beta-blocker therapy for ≥1 year was associated with a lower risk of all-cause death compared with beta-blocker for <1 year in patients without HF after AMI.
- A randomized controlled trial, the CAPITAL-RCT, did not suggest benefit of long-term beta-blocker therapy added to evidence-based medications in STEMI patients without HF treated with primary PCI.
- Given significant limitations of the current analysis, a large randomized clinical trial is indicated to assess the effect and optimal duration of beta-blocker therapy after MI in patients without HF who receive current guideline-directed treatments.
Study Questions:
What is the association between long-term beta-blocker therapy and clinical outcomes in patients without heart failure (HF) after acute myocardial infarction (AMI)?
Methods:
The investigators enrolled a total of 28,970 patients who underwent coronary revascularization for AMI with beta-blocker prescription at hospital discharge and were event-free from death, recurrent MI, or HF for 1 year from Korean nationwide medical insurance data. The primary outcome was all-cause death. The secondary outcomes were recurrent MI, hospitalization for new HF, and a composite of all-cause death, recurrent MI, or hospitalization for new HF. Outcomes were compared between beta-blocker therapy for ≥1 year (n = 22,707) and beta-blocker therapy for <1 year (n = 6,263) using landmark analysis at 1 year after index MI.
Results:
Compared with patients receiving beta-blocker therapy for <1 year, those receiving beta-blocker therapy for ≥1 year had significantly lower risks of all-cause death (adjusted hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.72-0.91) and composite of all-cause death, recurrent MI, or hospitalization for new HF (adjusted HR, 0.82; 95% CI, 0.75-0.89), but not the risks of recurrent MI or hospitalization for new HF. The lower risk of all-cause death associated with persistent beta-blocker therapy was observed beyond 2 years (adjusted HR, 0.86; 95% CI, 0.75-0.99) but not beyond 3 years (adjusted HR, 0.87; 95% CI, 0.73-1.03) after MI.
Conclusions:
The authors concluded that beta-blocker therapy for ≥1 year after MI was associated with reduced all-cause death among patients with AMI without HF.
Perspective:
This nationwide cohort study reports that beta-blocker therapy for ≥1 year was associated with a lower risk of all-cause death compared with beta-blocker for <1 year in patients without HF after AMI. Furthermore, the beneficial effects of beta-blocker were consistent across various subgroups. Of note, a randomized controlled trial, the CAPITAL-RCT (NCT01155635), did not suggest benefit of long-term beta-blocker therapy added to evidence-based medications in ST-segment elevation MI (STEMI) patients without HF treated with primary percutaneous coronary intervention (PCI). Given significant limitations of the current analysis, a large randomized clinical trial is indicated to assess the effect and optimal duration of beta-blocker therapy after MI in patients without HF who receive current guideline-directed treatments.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and SIHD, Acute Heart Failure, Interventions and ACS, Interventions and Vascular Medicine, Chronic Angina
Keywords: Acute Coronary Syndrome, Adrenergic beta-Antagonists, Heart Failure, Myocardial Infarction, Myocardial Revascularization, Patient Discharge, Percutaneous Coronary Intervention, Primary Prevention, ST Elevation Myocardial Infarction, Risk Reduction Behavior, Treatment Outcome
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