Key result
In patients with mildly reduced ejection fraction after acute myocardial infarction, beta-blocker therapy at discharge was associated with a significantly lower risk of 2-year major adverse cardiac events (HR 0.68).
Why the study?
The number of patients with mildly reduced EF (41%-49%) after AMI has been increasing in the era of optimal therapy, but the association of beta-blockers or RAS inhibitors with outcomes needed investigation.
Does medical therapy with beta-blockers or RAS inhibitors at discharge improve 2-year clinical outcomes in patients with mildly reduced LVEF after acute myocardial infarction?
Observational (n=2,904)
Yes
Does medical therapy with beta-blockers or RAS inhibitors at discharge improve 2-year clinical outcomes in patients with mildly reduced LVEF after acute myocardial infarction?
Hazard Ratio: 0.68 (95% CI 0.5–0.93)
Absolute Event Rate: 8.7% vs 12.8%
p-value: p=.015
In patients with mildly reduced LVEF (41-49%) after acute myocardial infarction, discharge prescription of beta-blockers or RAS inhibitors is associated with improved 2-year clinical outcomes, supporting their use in this intermediate phenotype.
Supports beta-blockers and RAS inhibitors at discharge post-MI with mild LVEF reduction; hypothesis-generating pending RCTs.
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 = .015), and no significant interaction between EF ≤ 45% and > 45% was observed (Pinteraction = 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 = .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 = .010) without a significant interaction between EF ≤ 45% and > 45% (Pinteraction = 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 Mildly reduced left ventricular ejection fraction after acute myocardial infarction (n=2,904). Beta-blockers vs. No beta-blockers at discharge was evaluated on 2-year major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction, revascularization, and re-hospitalization due to heart failure (HR 0.68, 95% CI 0.50-0.93, p=.015). In patients with mildly reduced ejection fraction after acute myocardial infarction, beta-blocker therapy at discharge was associated with a significantly lower risk of 2-year major adverse cardiac events (HR 0.68).
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