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Long-Term Beta-Blocker Use After MI in Patients Without HF
Quick Takes
- Long-term beta-blocker use among MI patients without prior MI or HF was not associated with a reduced risk of CV death.
- Long-term beta-blocker use among MI patients without prior MI or HF was also not associated with reduced risk of recurrent MI or CV events.
Study Questions:
Are beta-blockers cardioprotective among patients with stable, optimally treated myocardial infarction (MI) and no heart failure (HF)?
Methods:
Data from Danish registries (National Patient Register and National Causes of Death Register), which includes patients with MI admitted between 2003 and 2018, were used for the present analysis. Patients 30-85 years of age who were included had experienced a first-time MI, had undergone coronary angiography or percutaneous coronary intervention (PCI) during admission, and were treated with both aspirin and statins post-discharge. Patients with a prior history of MI, prior beta-blocker use, or any alternative indication or contraindication for beta-blocker treatment were excluded. Follow-up began 3 months following discharge in patients alive, free of cardiovascular (CV) events or procedures to 3 years. Primary outcomes were CV death, recurrent MI, and a composite outcome of CV events.
Results:
A total of 30,177 stable, optimally treated MI patients were included in this study, of which 58% received acute PCI. At baseline, 82% of patients were on beta-blocker treatment (median age 61 years, 75% male), and 18% were not (median age 62 years, 68% male). Beta-blocker treatment was associated with a similar risk of CV death (absolute risk difference [ARD], 0.1%; 95% confidence interval [CI], -0.3% to 0.5%) compared to no beta-blocker treatment. Risk differences between patients receiving beta-blockers or not were also similar for recurrent MI (ARD, 0.2%; 95% CI, -0.7% to 1.2%), and the composite outcome of CV events (ARD, 1.2%; 95% CI, -0.2% to 2.7%).
Conclusions:
The investigators concluded that in this nationwide cohort study of stable, optimally treated MI patients without HF, no long-term effect of beta-blocker treatment on CV prognosis was observed after MI admission with follow-up from 3 months to 3 years.
Perspective:
These data suggest that long-term beta-blocker use is not associated with lower CV events after MI. However, it should be noted that this was not a randomized controlled design, and the population was limited to exclude those 35-85 years of age with HF or with prior MI.
Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Acute Coronary Syndrome, Adrenergic beta-Antagonists, Aspirin, Coronary Angiography, Heart Failure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Patient Discharge, Percutaneous Coronary Intervention, Reperfusion, Secondary Prevention
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