Beta-blocker use post-myocardial infarction was associated with an 11% reduction in all-cause mortality (HR 0.89), but no benefits beyond one year in patients without reduced ejection fraction.
Does beta-blocker use reduce all-cause mortality in patients post-myocardial infarction without reduced ejection fraction or heart failure?
Routine beta-blocker use post-myocardial infarction in the contemporary era may not provide mortality benefits for patients without reduced ejection fraction or heart failure, and may increase adverse events in those with preserved EF.
Abstract Aims The 2023 ESC guidelines for acute coronary syndrome note that contemporary data are heterogenous regarding beta-blocker (BB) use post-myocardial infarction (MI) in patients without reduced ejection fraction (EF) or heart failure (HF). We aimed to address the heterogeneity in contemporary data around BB post-MI in this population. Methods and results We searched six databases from 1 January 2000 to 1 September 2024 to identify contemporary studies enrolling MI patients without reduced EF (≤40%) or history of HF receiving BB at index MI and comparing outcomes between BB users and non-users. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular (CV) mortality. Random-effects meta-analysis was conducted using the restricted maximum likelihood method. There were 24 studies including 290 349 patients enrolled in the contemporary era. Overall, BB use was associated with a significant 11% reduction in all-cause mortality hazard ratio (HR), 0.89; 95% confidence interval (CI), 0.81–0.97; I2 = 40, however with moderate-to-high statistical heterogeneity. Pre-specified subgroup analyses demonstrate comparable all-cause mortality (HR, 0.99; 95% CI, 0.94–1.06; I2 = 0%), CV mortality (HR, 0.99; 95% CI, 0.85–1.15; I2 = 0%), and MACCE (HR, 1.24; 95% CI, 1.01–1.52; I2 = 0%) in patients with a 1-year event-free period, defined as no death, recurrent MI, or HF while on BB following index MI. In patients with no event-free period, meta-regression revealed that BB mortality benefits were modified by the study inclusion period (P = 0.01), reflecting a temporal trend of decreasing BB mortality benefits over time. Based on the temporal trend, in patients with preserved EF post-2010, BB exhibited no reduction in all-cause mortality (HR, 0.97; 95% CI, 0.90–1.04; I2 = 0%), but a non-significant trend towards increased CV mortality (HR, 1.29; 95% CI, 0.96–1.72; I2 = 0%) and a significant increase in MACCE (HR, 1.24; 95% CI, 1.01–1.52; I2 = 0%). Conclusion In the contemporary reperfusion era, BB may not confer additional mortality benefits beyond a 1-year event-free period post-MI in patients without reduced EF. Moreover, post-MI BB use was associated with detrimental effects in patients with preserved EF.
Chi et al. (2024) studied this question. Beta-blocker use post-myocardial infarction was associated with an 11% reduction in all-cause mortality (HR 0.89), but no benefits beyond one year in patients without reduced ejection fraction.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: