June 29, 2026Journal of the American College of Cardiology
Additive Beneficial Effects of Beta-Blockers to Angiotensin-Converting Enzyme Inhibitors in the Survival and Ventricular Enlargement (SAVE) Study fn1fn1This study was supported by a University-Industry grant from the Medical Research Council, Ottawa, Ontario, Canada and Bristol Myers Squibb, Montreal, Quebec, Canada.
Key result
Beta-blocker use is linked to ~30% lower CV death in asymptomatic LV dysfunction post-MI.
- 30% risk reduction
- 95% CI 12% to 44%
Why the study?
It was unknown whether the beneficial effects of beta-blockers are additive to ACE inhibitors in patients with asymptomatic left ventricular dysfunction after MI, and whether discharge neurohumoral activation predicts response.
Does beta-blocker use reduce cardiovascular mortality and morbidity in patients with asymptomatic left ventricular dysfunction after MI treated with captopril?
Population
Patients with asymptomatic left ventricular dysfunction after MI in the SAVE study
Comparison
Beta-blocker use vs no beta-blocker use at randomization
Design
Retrospective analysis of trial and substudy data
Authors
Discussion
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Member takes
Implication
Supports beta-blocker use in asymptomatic post-MI LV dysfunction; hypothesis-generating and requires prospective validation.
Key Points
- To assess the additive benefits of beta-blockers with ACE inhibitors in reducing cardiovascular events after myocardial infarction.
- Retrospective analysis of SAVE study data and neurohumoral substudy
- Used Cox proportional hazards models to analyze relationships
- Examined effects on cardiovascular mortality and morbidity in patients with left ventricular dysfunction.
- Beta-blocker use reduced cardiovascular death by 30% (95% CI 12% to 44%)
- Heart failure risk decreased by 21% (95% CI 3% to 36%)
- Recurrent MI showed a non-significant reduction of 11% (95% CI 13% to 31%).
Study Design
Type
Cohort
Structured PICO
Does beta-blocker use reduce cardiovascular mortality and morbidity in patients with asymptomatic left ventricular dysfunction after MI treated with captopril?
P
Population
Patients with asymptomatic left ventricular dysfunction after myocardial infarction.
E
Exposure
Beta-adrenergic blocking agent in addition to the use of the angiotensin-converting enzyme (ACE) inhibitor captopril
C
Comparator
No beta-blocker use (retrospective analysis of beta-blocker use at randomization)
O
Outcome
Cardiovascular mortality and morbidityhard clinical
Main Result
Effect estimate: 30% risk reduction (95% CI 12% to 44%)
Beta-blocker use at hospital discharge in patients with asymptomatic LV dysfunction post-MI provides additive benefits to captopril in reducing cardiovascular death and heart failure.
Cite This Study
Vantrimpont et al. (1997) conducted a cohort in Asymptomatic left ventricular dysfunction after myocardial infarction. Beta-blockers vs. No beta-blocker use was evaluated on Cardiovascular death (30% risk reduction, 95% CI 12% to 44%). Beta-blocker use in patients with asymptomatic left ventricular dysfunction after MI was associated with a 30% reduction in the risk of cardiovascular death (95% CI 12% to 44%).