Key result
Long-term beta-blocker therapy (≥1 year) did not reduce mortality in post-MI patients without heart failure (OR 0.800; 95% CI 0.559-1.145).
Why the study?
Beta-blockers are standard therapy post-MI based on prereperfusion-era data, leaving their long-term effectiveness unclear in post-MI patients without heart failure in the reperfusion era.
Does long-term beta-blocker therapy reduce mortality in post-MI patients without heart failure in the reperfusion era?
Meta-Analysis (n=217,532)
Does long-term beta-blocker therapy reduce mortality in post-MI patients without heart failure in the reperfusion era?
Odds Ratio: 0.8 (95% CI 0.559–1.145)
Long-term beta-blocker therapy does not reduce mortality in post-MI patients without heart failure in the reperfusion era, challenging current guideline recommendations.
Supports deprescribing beta-blockers in stable post-MI patients without heart failure; leaves open.
Beta-blockers are recommended as a standard treatment for patients who experience a myocardial infarction (MI). However, the evidence supporting this recommendation is based on the prereperfusion era data. This review aims to evaluate the effectiveness of long-term (≥1 year) beta-blocker therapy in post-MI patients without clinical heart failure (HF) in the reperfusion era. We included observational cohort studies, which compared at least 1 year use of beta-blockers to no beta-blockers in patients with an acute MI, but without HF. The clinical endpoint considered was all-cause mortality, except for cardiovascular death in one study. Five cohort studies and 217,532 patients were included. One study demonstrated a reduction in all-cause mortality with beta-blockers, whereas, in 4 studies, there was no difference in the death rate. The pooled estimate by random effect showed that beta-blocker treatment does not reduce mortality (odds ratio 0.800, 95% confidence interval 0.559-1.145) with high heterogeneity (I2 = 94%). This meta-analysis shows that the use of oral beta-blockers for 1 year or more does not reduce the mortality of MI patients without HF. Large randomized trials need to evaluate beta-blocker discontinuation after an acute MI.
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A 2022 study conducted a meta-analysis in Myocardial infarction without heart failure (n=217,532). Long-term beta-blocker therapy vs. No beta-blockers was evaluated on All-cause mortality (cardiovascular death in one study) (OR 0.800, 95% CI 0.559-1.145). Long-term beta-blocker therapy (≥1 year) did not reduce mortality in post-MI patients without heart failure (OR 0.800; 95% CI 0.559-1.145).
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