Beta-blocker therapy at discharge was associated with a 32% lower risk of 2-year major adverse cardiac events (HR 0.68) in patients with mildly reduced ejection fraction after acute myocardial infarction.
Observational (n=2,904)
Yes
Does medical therapy with beta-blockers or RAS inhibitors reduce major adverse cardiac events in patients with mildly reduced EF after acute myocardial infarction?
In patients with mildly reduced EF after AMI, discharge prescriptions of beta-blockers or RAS inhibitors are associated with significantly better 2-year clinical outcomes.
Effect estimate: HR 0.68 (95% CI 0.50-0.93)
Absolute Event Rate: 8.7% vs 12.8%
p-value: p=0.015
Abstract In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mildly reduced left ventricular ejection fraction (EF) (41 - 49%) have been increasing. This observational study aimed to investigate the association between the medical therapy with oral beta-blockers or inhibitors of renin-angiotensin system (RAS) and 2-year clinical outcomes in patients with mildly reduced EF after AMI. Among patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health, propensity-score matched patients who survived the initial attack and had mildly reduced EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Beta-blocker therapy at discharge was associated with lower 2-year major adverse cardiac events which was a composite of cardiac death, myocardial infarction, revascularization and re-hospitalization due to heart failure (8.7 vs. 12.8/100 patient-years; hazard ratio HR 0.68; 95% confidence interval CI 0.50-0.93; P =0.015), and no significant interaction between EF ≤45% and >45% was observed ( P interaction =0.354). This association was mainly driven by lower myocardial infarction in patients with beta-blockers (HR 0.50; 95% CI 0.26-0.95; P =0.035). Inhibitors of RAS at discharge were associated with lower re-hospitalization due to heart failure (1.8 vs. 3.5/100 patient-years; HR 0.53; 95% CI 0.33-0.86; P =0.010) without a significant interaction between EF ≤45% and >45% ( P interaction =0.333). In patients with mildly reduced EF after AMI, the medical therapy with beta-blockers or RAS inhibitors at discharge was associated with better 2-year clinical outcomes.
Joo et al. (Wed,) conducted a observational in Acute myocardial infarction with mildly reduced left ventricular ejection fraction (n=2,904). Beta-blockers vs. No beta-blockers was evaluated on 2-year major adverse cardiac events (MACE) (HR 0.68, 95% CI 0.50-0.93, p=0.015). Beta-blocker therapy at discharge was associated with a 32% lower risk of 2-year major adverse cardiac events (HR 0.68) in patients with mildly reduced ejection fraction after acute myocardial infarction.