Key result
Discharge beta-blockers linked to ~32% lower MACE risk in post-MI patients with mildly reduced EF.
Why the study?
With contemporary AMI therapy, patients with mildly reduced LVEF are increasing, but the association between beta-blocker or RAS inhibitor therapy and clinical outcomes in this group required investigation.
Does medical therapy with beta-blockers or RAS inhibitors reduce major adverse cardiac events in patients with mildly reduced EF 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?
Effect estimate: HR 0.68 (95% CI 0.50-0.93)
Absolute Event Rate: 8.7% vs 12.8%
p-value: p=0.015
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.
Supports beta-blocker discharge prescription post-AMI with mild EF reduction; extends weak observational data but leaves randomized confirmation open.
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.
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Joo et al. (2022) conducted an 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.
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