Prevention of acute coronary events: before… and thereafter

This issue of the European Journal of Preventive Cardiology focuses on primary and secondary prevention of acute coronary syndromes (ACS). The role of beta-blockers in secondary prevention after ACS remains uncertain in the new era after revascularization and modern preventive therapies, particularly in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF). In ‘Safety of beta-blocker discontinuation after acute coronary syndromes with preserved or mildly reduced left ventricular ejection fraction: a target trial emulation from a real-world cohort’, Johner et al.1 compared patients who continued beta-blockers at 1 year with those who discontinued therapy within 12 months post-ACS, following them for an additional 4 years. The primary endpoint—major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction (MI), stroke, transient ischaemic attack, unplanned revascularization, or unstable angina hospitalization—showed no significant difference between groups (14.1% vs. 14.3%). These findings suggest that discontinuing beta-blockers after 12 months in patients with LVEF ≥ 40% does not increase MACE risk.