Key result
Universal beta-blockers after STEMI show no benefit for 1-year mortality or CV readmission.
Why the study?
Beta-blockers were standard after STEMI in the pre-reperfusion era, but contemporary evidence for secondary prevention remains scarce.
Does beta-blocker therapy at hospital discharge reduce the composite of all-cause mortality or CV hospital re-admission at 1 year in patients after STEMI?
Observational (n=3,145)
Yes
Does beta-blocker therapy at hospital discharge reduce the composite of all-cause mortality or CV hospital re-admission at 1 year in patients after STEMI?
Effect estimate: HR 0.73 (95% CI 0.51-1.04)
p-value: p=0.081
Routine beta-blocker therapy after STEMI may not improve 1-year outcomes in patients with preserved or mid-range LVEF, but remains beneficial for those with reduced LVEF.
May not support routine beta-blockers post-STEMI with preserved LVEF; leaves open benefit in reduced LVEF pending RCTs.
The use of beta-blockers (BB) in the context of ST-segment elevation myocardial infarction (STEMI) was a universal practice in the pre-reperfusion era. Since then, evidence of their use for secondary prevention after STEMI is scarce. Our aim is to determine treatment results associated with BB therapy after a STEMI at 1-year follow-up in a contemporary nationwide cohort.A prospective analysis involving 49 national centers, including patients admitted with STEMI, enrolled between October 2010 and September 2019 was conducted. The primary outcome was defined as the composite of all-cause mortality or hospital re-admission for a cardiovascular (CV) cause in the first year after STEMI. The patients were distributed into 2 groups, depending on whether they received therapy with BB at hospital discharge or not (BB and NB group, respectively).A total of 3145 patients were included in the analysis, of which 2526 (80.3%) in the BB group. A total of 12.2% of patients reached the primary outcome. Regarding the univariate Cox regression analysis, the BB group presented lower mortality or re-admission for CV cause at 1-year follow-up [hazard ratio (HR) 0.69, confidence interval (CI) 95% 0.55-0.87, P = .001]. However, after adjustment for significant covariates, this association was lost (HR 0.73, CI 95% 0.51-1.04, P = .081). In patients with preserved (HR 0.73, CI 95% 0.51-1.04, P = .081) and mid-range (HR 1.01, CI 95% 0.64-1.61, P = .959) left ventricular ejection fraction (LVEF), the primary outcome was similar between the 2 groups, while in patients with reduced LVEF, the BB group presented a better prognosis, with fewer patients reaching the primary outcome (HR 0.431, CI 95% 0.262-0.703, P = .001).BB universal therapy after STEMI has not proved useful, but it seems to be beneficial in patients with reduced LVEF.
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Ferreira et al. (2021) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=3,145). Beta-blocker therapy at hospital discharge vs. No beta-blocker therapy at hospital discharge was evaluated on Composite of all-cause mortality or hospital re-admission for a cardiovascular cause at 1 year (HR 0.73, 95% CI 0.51-1.04, p=0.081). Universal beta-blocker therapy at discharge after ST-elevation myocardial infarction did not significantly reduce the 1-year composite risk of all-cause mortality or cardiovascular re-admission (adjusted HR 0.73).
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