Patients on beta-blockers with prior myocardial infarction (MI) but without heart failure (HF) had a lower risk of recurrent MI and lower composite cardiovascular outcomes, results from a study indicated.

While beta-blockers are "widely regarded as one of the most important therapies in clinical medicine of the 20th century," according to the study authors, their role in the long-term reduction of cardiovascular (CV) outcomes remains controversial. With this in mind, the researchers for the CHARISMA trial included a total of 15,603 patients: 4,772 patients with prior MI, 7,804 patients with known atherothrombosis, and 2,101 patients without HF but also with risk factors in the study. Patients with a history of HF were excluded from the study (n = 926). Patients were then divided into two groups based on baseline beta-blocker use.

The primary endpoint was a composite of nonfatal MI, stroke from any cause, or CV death. The authors used Cox proportional hazard models to determine the effects of prior beta-blocker use and the primary study endpoint, and used propensity score matching for each cohort.

The use of beta-blockers was associated with a 31% lower risk of the primary outcome in the propensity score-matched prior MI cohort (70 [7.1%] vs. 100 [10.2%]; HR = 0.69, 95% CI, 0.50-0.94; p = 0.021). This risk reduction was driven primarily by a reduction in recurrent MI risk (33 [3.4%] vs. 48 [4.9%]; HR = 0.62, 95% CI, 0.39-1.00; p = 0.049), although there was no reduction in mortality. There was a trend for an increase in stroke risk in the risk factors alone cohort, which was shown to be significant in the regression model once adjusted to the propensity score (p = 0.006), as well as in multivariable models. The researchers reported no differences in mortality, CV mortality, stroke, or hospitalization in the atherothrombotic disease and risk factor alone cohorts.

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Bangalore S, Bhatt D, Steg G. Circ Cardiovasc Qual Outcomes. 2014;doi:10.1161/CIRCOUTCOMES.114.0010.73

Keywords: Myocardial Infarction, Stroke, Propensity Score, Adrenergic beta-Antagonists, Risk Reduction Behavior, Heart Failure, Hospitalization

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