Key result
Combined discharge beta-blockers and ACEI/ARB linked to ~30% lower 12-month MACE after MI revascularization.
Why the study?
Pivotal trials of beta-blockers and ACEI/ARB in acute myocardial infarction were largely conducted before widespread adoption of early revascularization.
Does the prescription of beta-blockers and/or ACEI/ARB at discharge reduce 12-month MACE and mortality in patients with acute myocardial infarction managed with inhospital coronary revascularization?
Cohort (n=15,073)
Yes
Does the prescription of beta-blockers and/or ACEI/ARB at discharge reduce 12-month MACE and mortality in patients with acute myocardial infarction managed with inhospital coronary revascularization?
Answers are grounded in this paper and cite their sources.
In patients with acute myocardial infarction undergoing inhospital revascularization, prescription of both beta-blockers and ACEI/ARBs at discharge is associated with significantly lower 12-month mortality and MACE, regardless of LVEF.
Pivotal trials of beta-blockers (BB) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) in acute myocardial infarction (AMI) were largely conducted prior to the widespread adoption of early revascularization. A total of 15,073 patients with AMI who underwent inhospital coronary revascularization from January 2007 to December 2013 were analyzed. At 12 months, BB was significantly associated with a lower incidence of major adverse cardiovascular events (MACE, adjusted HR 0.80, 95% CI 0.70-0.93) and all-cause mortality (adjusted HR 0.69, 95% CI 0.55-0.88), while ACEI/ARB was significantly associated with lower all-cause mortality (adjusted HR 0.80, 95% CI 0.66-0.98) and heart failure (HF) hospitalization (adjusted HR 0.80, 95% CI 0.68-0.95). Combined BB and ACEI/ARB use was associated with the lowest incidence of MACE (adjusted HR 0.70, 95% CI 0.57-0.86), all-cause mortality (adjusted HR 0.55, 95% CI 0.40-0.77) and HF hospitalization (adjusted HR 0.64, 95% CI 0.48-0.86). This were consistent for left ventricular ejection fraction < 50% or ≥ 50%. In conclusion, in AMI managed with revascularization, both BB and ACEI/ARB were associated with a lower incidence of 12-month all-cause mortality. Combined BB and ACEI/ARB was associated with the lowest incidence of all-cause mortality and HF hospitalization.
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Sim et al. (2020) conducted a cohort in Acute myocardial infarction (n=15,073). Beta-blockers and ACEI/ARB vs. No beta-blockers and no ACEI/ARB was evaluated on Major adverse cardiovascular events (MACE) (HR 0.70, 95% CI 0.57-0.86). Combined use of beta-blockers and ACEI/ARB at discharge in patients with acute myocardial infarction managed with revascularization was associated with a reduced incidence of 12-month MACE (HR 0.70).
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