Beta-blocker therapy and angina pectoris after myocardial infarction: a BETAMI-DANBLOCK substudy

Abstract Background Angina pectoris after myocardial infarction (MI) remains prevalent despite contemporary treatment strategies and affects quality of life and healthcare use. The evidence for the effects of beta-blocker therapy on angina pectoris in MI patients treated according to contemporary standards is limited. Purpose We aimed to evaluate the effects of beta-blockers on diagnostic procedures and hospitalizations for angina pectoris, as well as redeemed anti-anginal prescriptions and self-reported symptoms of angina among MI patients with LVEF ≥40% enrolled in the BETAMI-DANBLOCK trial. Methods Participants in the BETAMI-DANBLOCK trial were randomized to open-label long-term beta-blocker therapy or no such therapy within 14 days from MI. In this pre-specified substudy, we analyzed the effect of beta-blocker therapy on time to first diagnostic procedure (coronary angiogram, coronary CT angiography, PET-CT, myocardial perfusion scintigraphy, or stress echocardiography), hospitalization for angina, and ≥2 redeemed prescriptions for anti-anginal medications (calcium-antagonists, short-/long-acting nitrates) using Fine-Gray subdistribution hazards models with death as a competing risk. Self-reported angina symptoms were measured using the Canadian Cardiovascular Society angina grading and the New York Heart Association functional classification. Differences in self-reported symptoms (symptoms vs. no symptoms) at 1 year were compared between treatment groups using the chi-square test. Results In the DANBLOCK trial, 1352 patients were randomized to beta-blockers and 1355 to no beta-blockers. After a median follow-up of 3.5 years, 329 patients (24.3%) in the beta-blocker group and 395 patients (29.2%) in the no beta-blocker group underwent at least one diagnostic procedure for angina pectoris (subdistribution hazard ratio sHR 0.85; 95% confidence interval CI 0.74-0.99) (Table 1). Hospitalization for angina pectoris occurred in 59 patients (4.4%) in the beta-blocker group and 60 patients (4.4%) in the no beta-blocker group (sHR 0.99; 95% CI 0.69-1.42). A higher proportion of patients in the no-beta-blocker group redeemed ≥2 prescriptions for calcium-antagonists, whereas no difference was seen for nitrates (Table 1). Self-reported angina symptoms at 1 year did not differ significantly between treatment groups (Table 2). If accepted for presentation at the ESC Preventive Cardiology 2026 the results from BETAMI will also be included. Conclusion Among MI patients with LVEF ≥40%, beta-blocker therapy was associated with a lower risk of undergoing a diagnostic procedure for angina pectoris, and of redeeming ≥2 prescriptions for calcium antagonists, but not with a lower risk of hospitalization for angina pectoris. Self-reported angina symptoms appeared similar between treatment groups.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.